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.
“1. Haïssaguerre M, Derval N, Sacher F, et al. Sudden Cardiac Arrest Associated with Early Repolarization. New England Journal of Medicine. 2008;358(19):2016-2023.
2. Ginzton LE, Laks MM. The differential diagnosis of acute pericarditis from the normal variant: New electrocardiographic criteria. Circulation. 1982;65(5):1004-1009.
3. Wagner GS, Strauss DG. Marriott’s Practical Electrocardiography. 12th ed. Lippincott Williams & Wilkins; 2014.
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.”