Early repolarization with a constant ST-segment elevation in leads II, III, and AVF: Heritability and follow-up results

Abstract

Background: A recent scientific statement from the American Heart Association included ST-segment elevation in the absence of chest pain in the definition of early repolarization (ER). ST-elevation at J-point termination (Jt)-point was not taken into account in previous heritability studies. The relevance of ST-elevation at Jt point (especially in inferior leads) is not evident enough. Our aim was to assess the heritability of ER with ST-elevation in inferior leads among offspring of such patients and patients' follow-up results. Materials and Methods: A prospective study of 16 consecutive patients with inferior ST-elevation at Jt ≥0.1 mV, who have arrived to outpatient department most often due to chest pain not associated with coronary stenosis according to multislice computed tomography angiography, started in 2013. Repeated cardiologist evaluation included their 12 children in 2017. Comparisons were made with 16 age- and gender-matched control patients' rest 12-lead electrocardiograms (ECGs) from the outpatient department of year 2018. Impact of ST-elevation's localization and sex on heritability were assessed by odds ratio (OR) with 95% confidence interval (CI). Results: There were no significant changes of patients' (all men) health and ECGs during follow-up. Eight (66.7%) of their children were ECG-positive versus 1 (6.2%) control patient,P = 0.001. All siblings (from the same father) of 5 (62.5%) ECG-positive children were ECG-positive. Two of the 5 (male and female) underwent detailed evaluation, including cardiac magnetic resonance, without abnormalities. In cases of only inferior father's ST-elevation, OR, 3.00; 95%CI, 0.24-37.7, and for male children, OR, 7.00; 95%CI, 0.400-23, for presenting with this pattern. Conclusions: Constant inferior ST-elevation, even in cases of chest pain, maybe ER, heritable without structural abnormalities. Heritability may be greater for male offspring and in cases of only inferior father's ST-elevation. Longer studies are necessary to confirm that it is benign. We suggest the term “a constant ST-segment elevation (at Jt)” instead of “ST-segment elevation in the absence of chest pain,” with adding that it is possible latent, depending on the heart rate.

Keywords

• chest pain
• constant st-segment elevation
• early repolarization
• inherited electrocardiographic disorders