CASE REPORT PATIENT WITH SUDDEN CARDIAC ARREST IN EARLY REPOLARIZATION SYNDROME

Adnyana KSP, Herman H, Putri EN, Mulyono MT, Yugo D

Cardiologist, General Practitioner, and Internship of RSUD Tarakan

BACKGROUND

Early repolarization It is not uncommon electrocardiographic finding, it happen in 3% to 24% of the

population. Young individuals, especially those predisposed to vagotonia, males, African Americans, and
athletes are subpopulations known to have a higher prevalence of ERS In a decade ER thought to be a
benign pattern in ECG, but in some study it can induce idiopathic ventricular fibrillation that causes
syncope and cardiac arrest. One study showed ER was noticed in 18.5% in patients with syncope
compared to 2% in healthy controls, this equates to almost 10 - fold increase risk of syncope in patients
with ERS.

CASE
Women, 39 years old brought to emergency department in RSUD Tarakan with suddenly lost
consciousness when she doing her task at home. First of all patient feel unwell, sweating, vomiting and
then suddenly lost her conscious. Patient doesn’t have any history of cardiac disease or another disease
before. ECG examination show patient have ventricular fibrillation and defibrillation procedure done to
her for emergency treatment but she have recurrent ventricular fibrillation. From laboratory finding she
have low potassium level (2,84 mmol/I). After three times of defibrillation patient have another ECG
examination and show patient have early repolarization pattern in all lead extremity and precordial.
Trans thoracic echo show a normal result. After five days of hospitalize patient then referred to Advance
Cardiac Centre having implantable cardioverter defibrillation.

DISCUSSION

Early repolarization (ER), also recognized as “J-waves” or “J-point elevation”’ is an electrocardiographic

abnormality consistent with elevation of the junction between the end of the QRS complex and the
beginning of the ST segment in 2 contiguous leads. This ECG pattern known as benign or variant of
normal ECG but in some cases it can cause idiopathic ventricular fibrillation. A study showed three
subtype of early repolarization syndrome, type 1 it shows ER in the lateral precordial leads that is seen
in healthy male athletes and has the lowest risk of malignant arrhythmias, type 2 it show ER in inferior
and inferolateral leads and is associated with greater risk malignant arrhythmias, and type 3 it show ER
pattern in all ECG leads and has the highest risk of malignant arrhythmias and electrical storm.

CONCLUSION

Patient with early repolarization syndrome should have a thorough history background check. Presence
of syncope or family history of sudden cardiac death should be the alarming signs for unfavorable
outcome.

KEYWORD: Early Repolarization Syndrome, Ventricular Fibrillation, Cardiac death, Syncope,