Early Repolarisation

Report:

Sinus rhythm 58/min

Vertical heart position

Axis +97o

LVH voltage, normal for age

ST segment elevation in the inferior leads, c/w early repolarisation

Anteroseptal T wave inversion, normal for age

Comment:

The entire tracing is almost certainly within normal limits for a man of 20. The report given above has, however, a descriptive merit.

There is no proper indication for taking an ECG on a healthy young man even if he is to undergo general anæsthesia.

The inferior ST segment elevation has no reciprocal ST depression counterpart; indeed, in leads V1-3 there is also some elevation. In the latter leads, the T waves have preserved the so-called “juvenile pattern”, a normal variant. It can at times be quite striking, especially in young adult Negroes83.

The early repolarisation itself has for a long time been regarded as completely inocuous normal variant, but some association with sudden death has muddied the waters in recent years84. Given the prevalence of 2 – 5% of the condition in normal population and the rarity of VF associated with early repolarisation the link may not be significant.

Another example, of early repolarisation in the anterior leads, is shown below (Fig 114a) and another in Case 59.