Outcome of patients with idiopathic ventricular fibrillation and correlation with ECG markers of early repolarization

Clin Res Cardiol. 2023 Dec;112(12):1748-1753. doi: 10.1007/s00392-022-02125-9. Epub 2022 Nov 19.

Abstract

Background: Early repolarization pattern (ERP) has been associated with idiopathic ventricular fibrillation (IVF) and with cardiovascular mortality in the general population. As there is limited data about long- term outcome of IVF, the aim of our study was to observe ventricular arrhythmia (VA) recurrences in these patients and to identify a possible correlation of VA with ECG markers of early repolarization.

Methods and results: We investigated 56 consecutive IVF patients who received an implantable cardioverter-defibrillator for secondary prevention. ERP was defined as a J-point elevation ≥ 0.1 mV in two or more contiguous inferior or lateral leads. Markers of early repolarization were present in 32.1% of cases with a preponderance of QRS slurring (77.8%). During a mean follow-up of 41.2 months, 11 patients (19.6%) received in total 18 adequate ICD-therapies. VF was most the common cause for ICDtherapy (61.1%) but monomorphic VT also occurred in four patients. Presence of ERP was associated with a significant trend towards arrhythmia recurrences. 38.9% patients with ERP received appropriate ICD-therapies whereas only 10.5% of patients without ERP had arrhythmia recurrence (p = 0.05). Inappropriate ICD-therapies occurred in seven patients (12.5%) with a non-significant trend towards a higher incidence in patients with a transvenous ICD (p = 0.15).

Conclusion: A significant correlation between ERP and VA recurrences in patients with IVF could be observed. Though monomorphic VA also play a role in the studied IVF-population, our data support the use of the S-ICD in this collective.

Keywords: Early repolarization; Idiopathic ventricular fibrillation; S-ICD.

MeSH terms

  • Arrhythmias, Cardiac / etiology
  • Defibrillators, Implantable* / adverse effects
  • Electrocardiography
  • Heart
  • Humans
  • Tachycardia, Ventricular*
  • Ventricular Fibrillation / diagnosis
  • Ventricular Fibrillation / therapy

Supplementary concepts

  • Paroxysmal ventricular fibrillation