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The Early Repolarisation pattern in athletes: Definitions and prognostic significance

Sports Cardiology Quiz


Dr Greg Mellor, Cardiology research fellow, St George’s university of London
Dr Michael Papadakis, Lecturer in cardiology, St George’s university of London
Prof Sanjay Sharma, Professor of clinical cardiology, St George’s university of London

Sports Cardiology

The case:

A 32 year-old, male, Caucasian professional cyclist attended for routine pre-participation screening as mandated by the Union Cycliste International (UCI). He was asymptomatic and had no family history of sudden death or of cardiac pathology. He trained for 30 hours per week. His 12 lead ECG is shown below:




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for further reading:

[*1] Sudden cardiac arrest associated with early repolarization.
Haïssaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, Roy L de, Pasquié J-L, Nogami A, Babuty D, Yli-Mayry S, Chillou C De, Scanu P, Mabo P, Matsuo S, Probst V, Scouarnec S Le, Defaye P, Schlaepfer J, Rostock T, Lacroix D, Lamaison D, Lavergne T, Aizawa Y, Englund A, Anselme F, O’Neill M, Hocini M, Lim KT, Knecht S, Veenhuyzen GD, et al.  
N Engl J Med. 2008;358:2016–2023.
[*2] Long-term outcome associated with early repolarization on electrocardiography.
Tikkanen JT, Anttonen O, Junttila MJ, Aro AL, Kerola T, Rissanen H a, Reunanen A, Huikuri H V.  
N Engl J Med. 2009;361:2529–2537.
[*3] Early repolarization: electrocardiographic phenotypes associated with favorable long-term outcome.
Tikkanen JT, Junttila MJ, Anttonen O, Aro AL, Luttinen S, Kerola T, Sager SJ, Rissanen H a, Myerburg RJ, Reunanen A, Huikuri H V.  
Circulation. 2011;123:2666–2673.
[*4] Association of early repolarization pattern on ECG with risk of cardiac and all-cause mortality: a population-based prospective cohort study.
Sinner MF, Reinhard W, Müller M, Beckmann B-M, Martens E, Perz S, Pfeufer A, Winogradow J, Stark K, Meisinger C, Wichmann H-E, Peters A, Riegger G a J, Steinbeck G, Hengstenberg C, Kääb S. (MONICA/KORA).
PLoS Med. 2010;7:e1000314. 
[*5] Prevalence, prognosis, and identification of the malignant form of early repolarization pattern in a population-based study.  
Rollin A, Maury P, Bongard V, Sacher F, Delay M, Duparc A, Mondoly P, Carrié D, Ferrières J, Ruidavets J-B.
Am J Cardiol. 2012;110:1302–1308.
[*6] Early repolarization pattern in competitive athletes: clinical correlates and the effects of exercise training.
Noseworthy P a, Weiner R, Kim J, Keelara V, Wang F, Berkstresser B, Wood MJ, Wang TJ, Picard MH, Hutter AM, Newton-Cheh C, Baggish AL.
Circ Arrhythm Electrophysiol. 2011;4:432–440.
[*7] Recommendations for interpretation of 12-lead electrocardiogram in the athlete.
Corrado D, Pelliccia A, Heidbuchel H, Sharma S, Link M, Basso C, Biffi A, Buja G, Delise P, Gussac I, Anastasakis A, Borjesson M, Bjørnstad HH, Carrè F, Deligiannis A, Dugmore D, Fagard R, Hoogsteen J, Mellwig KP, Panhuyzen-Goedkoop N, Solberg E, Vanhees L, Drezner J, Estes N a M, Iliceto S, Maron BJ, Peidro R, Schwartz PJ, Stein R, Thiene G, et al.
Eur Heart J. 2010;31:243–259.