Early repolarization
Also calledER · early repolarization pattern · ERP · benign early repolarization · BER
Definition
J-point elevation of at least 0.1 mV (1 mm) in two or more contiguous inferior and/or lateral leads, appearing as either a slur or a distinct notch (J wave) at the end of the QRS complex, with or without ST-segment elevation. The pattern is common, especially in young people and highly trained athletes, and has traditionally been regarded as benign. Early repolarization syndrome is a separate diagnosis: the same ECG pattern in a person resuscitated from otherwise unexplained ventricular fibrillation or polymorphic ventricular tachycardia, or in a sudden-death victim with a negative autopsy whose earlier ECG showed the pattern.
Clinical noteThe ST segment after the J point helps separate risk. In a middle-aged general population, early repolarization followed by a horizontal or descending ST segment carried a higher risk of arrhythmic death, more so when the J-point elevation exceeded 0.2 mV in the inferior leads; a rapidly ascending ST segment, the usual form in athletes, carried no added risk.
Sources
- Priori SG, Wilde AA, Horie M, et al. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Heart Rhythm. 2013;10(12):1932-1963. doi.org/10.1016/j.hrthm.2013.05.014
- Macfarlane PW, Antzelevitch C, Haissaguerre M, et al. The early repolarization pattern: a consensus paper. J Am Coll Cardiol. 2015;66(4):470-477. doi.org/10.1016/j.jacc.2015.05.033
- Tikkanen JT, Junttila MJ, Anttonen O, et al. Early repolarization: electrocardiographic phenotypes associated with favorable long-term outcome. Circulation. 2011;123(23):2666-2673. doi.org/10.1161/CIRCULATIONAHA.110.014068
- Antzelevitch C, Yan GX, Ackerman MJ, et al. J-wave syndromes expert consensus conference report: emerging concepts and gaps in knowledge. Heart Rhythm. 2016;13(10):e295-e324. doi.org/10.1016/j.hrthm.2016.05.024
Last reviewed 2 October 2026. Every definition in the EKG Dictionary cites the guideline, consensus statement or original paper it comes from.