Early Repolarization

Electrocardiographic features of early repolarization include diffuse ST elevations that are most pronounced in the precordial leads (typically V2-5) and in proportion to the amplitude of the QRS complex. The degree of ST elevation in V6 should be less than 25% the height of the QRS (greater than 25% suggests pericarditis). J point notching (i.e., “fishhook”) can be seen. The T waves should be concordant (same direction as QRS), and there should not be any reciprocal changes to suggest myocardial infarction. When the diagnosis is in doubt, a calculator to help differentiate early repolarization from a subtle anterior ST-elevation myocardial infarction may be useful.


ST elevation can be clearly seen in the above leads. Lead II has J point notching (i.e., “fishhook”), characteristic of early repolarization.



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  4. Driver BE, Khalil A, Henry T, Kazmi F, Adil A, Smith SW. A new 4-variable formula to differentiate normal variant ST segment elevation in V2-V4 (early repolarization) from subtle left anterior descending coronary occlusion – Adding QRS amplitude of V2 improves the model. J Electrocardiol. 2017;50(5):561-569.