ECG Phenomena of the Early Ventricular Repolarization in the 21 Century

Clinical interest in electrocardiographic (ECG) phenomena of early ventricular repolarization (EVR) has been rekindled recently mainly because of their clinically established association with fatal cardiac arrhythmias, particularly in otherwise healthy individuals with no (or minimal) structural diseases of the heart. ECG phenomena of EVR have often been misdiagnosed, misinterpreted, or undermined. This happened mainly because of prevailing opinion of the"benign" or "misleading" nature of various EVR phenomena. For instance, early repolarization changes consistent with Brugada syndrome have been interpreted "innocent" and overlooked for decades until 1992.1 Another example so-called "early repolarization syndrome" (ERS) that universally and unequivocally has been regarded as "normal", "normal variant", "benign early repolarization" until 2000.2 In 2008, seminal article by Haïssaguerre et al.3 accompanied by editorial comments by Wellens4 and letter to the editor by Nam et al.5 brought clinical attention to an increased prevalence of the ERS among patients with a history of idiopathic ventricular fibrillation (VF).