Abnormal epicardial electrophysiologic substrate in patients with early repolarization pattern and reduced left ventricular systolic function: A report of two cases

Introduction Early repolarization pattern (ERP) in the electrocardiogram (ECG) refers to ST-segment elevation above the isoelectric line in the absence of chest pain and/or to terminal QRS slurring or notching in 2 contiguous inferior and/or lateral leads. The underlying electrophysiologic mechanism of ERP remains elusive and is likely heterogeneous. The latter is supported by the fact that although ERP is commonly observed in the general population and has long been considered as a benign ECG finding, some recent data suggest its link (albeit weak) to increased risk of sudden cardiac death. In addition, different ECG markers of ERP may carry diverse prognostic significance while inferior J-point elevation of 2 mm appears to be the most strongly linked to arrhythmic death. Finally, the electrophysiologic mechanism of ERP may vary in patients with and without a structural heart disease. In this report, we describe electrophysiologic substrate in 2 patients with mild idiopathic left ventricle (LV) systolic dysfunction and terminal QRS notching (J-point elevation) in inferolateral leads.