CORRESPONDENCE: LETTER TO THE EDITOR
Early Repolarization in the Athlete
Massimiliano Bianco, MD and
Paolo Zeppilli, MD*
* Sports Medicine Department, Institute of Internal Medicine and Geriatrics, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy (Email: p.zeppilli{at}rm.unicatt.it).
An "abnormal" resting electrocardiogram is common in top-ranking, endurance-trained athletes (1). These abnormalities belong to physiological changes induced by training, as sinus bradycardia, high QRS and T-wave voltages, and early repolarization (ER), consisting of an elevation of QRS–ST junction, or a QRS notching/slurring. Until now, ER has been considered benign (2).
In a previous article (3), we underlined differences between ventricular repolarization anomalies in top-level athletes and those present in patients with Brugada syndrome. ER was observed in 89% of athletes, a value largely different from what was recently observed by Rosso et al. (4) in a young athletic group (22%).
The difference in ER prevalence between our athletes and those studied by Rosso et al. (4) could be that the former were competitive athletes and the Rosso et al. (4) subjects were noncompetitive. Moreover, in this study, different from the control group, the athletic patients were not age-matched with patients with idiopathic ventricular fibrillation (IVF) and were younger (range 17 to 19 years vs. 24 to 70 years). So, the difference in the prevalence of J-point elevation in IVF subjects (42%) may be due more to the younger age than to athletic conditioning. We observed a similar ER prevalence (36%) in our young nonathletic controls (mean age, 25 years) (3).
Recently, it was suggested that, in some cases, ER may not be benign (4,5). We would like to stress that top-level endurance-trained athletes represent a peculiar group of subjects in whom ER and some other electrocardiogram anomalies are almost the rule. None of our athletes has suffered from major ventricular arrhythmias from the time of the study onward (3). In this way, the meaning of ER, in particular, in left pre-cordial leads, especially when associated with high QRS and T-wave voltages, must be considered a complete benign phenomenon, reversible after a few months of detraining.
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1. Zeppilli P. The athlete's heart: differentiation of training effects from organic heart disease Practical Cardiol 1988;14:61.2. Wasserburger RH, Alt WJ. The normal RS-T segment elevation variant Am J Cardiol 1961;8:184-192.[CrossRef][Web of Science][Medline] 3. Bianco M, Bria S, Gianfelici A, et al. Does early repolarization in the athlete have analogies with the Brugada syndrome? Eur Heart J 2001;22:504-510.[Abstract/Free Full Text] 4. Rosso R, Kogan E, Belhassen B, et al. J-point elevation in survivors of primary ventricular fibrillation and matched control subjects J Am Coll Cardiol 2008;52:1231-1238.[Abstract/Free Full Text] 5. Haïssaguerre M, Derval N, Sacher F, et al. Sudden cardiac arrest associated with early repolarization N Engl J Med 2008;358:2016-2023.[Abstract/Free Full Text]
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J. Am. Coll. Cardiol. 2009 53: 2200.
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