Long-Term Risk of Incident Arrhythmias Associated With Early Repolarization Pattern ― The Atherosclerosis Risk in Communities (ARIC) Study
Background: The early repolarization pattern (ERP) is associated with cardiovascular death, but its connection with arrhythmias remains unknown. This study evaluated relationships between ERP and incident arrhythmias, including ventricular arrhythmias, bradyarrhythmias, and atrial fibrillation (AF)/...
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| Published in | Circulation Journal Vol. 89; no. 6; pp. 809 - 818 |
|---|---|
| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Japan
The Japanese Circulation Society
23.05.2025
一般社団法人 日本循環器学会 |
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| Abstract | Background: The early repolarization pattern (ERP) is associated with cardiovascular death, but its connection with arrhythmias remains unknown. This study evaluated relationships between ERP and incident arrhythmias, including ventricular arrhythmias, bradyarrhythmias, and atrial fibrillation (AF)/flutter (Afl).Methods and Results: We analyzed 14,679 middle-aged (45–64 years) participants from the Atherosclerosis Risk in Communities cohort, a prospective population-based study in the US. Participants were monitored for ERP status at baseline and at 3 subsequent follow-up visits. We examined associations between incident arrhythmias and baseline ERP, time-varying ERP, time-updated ERP, and changes in ERP over time using Cox models to estimate hazard ratios (HRs) adjusted for potential confounders. Over a 20-year follow-up, there were 1,252 ventricular arrhythmias, 890 bradyarrhythmias, and 2,202 cases of AF. Time-updated ERP was associated with increased HRs for ventricular arrhythmias (1.55; 95% confidence interval [CI] 1.35–1.77), bradyarrhythmias (1.76; 95% CI 1.48–2.08), and AF (1.25; 95% CI 1.10–1.43). Time-varying ERP also showed associations with these outcomes. Compared with individuals with consistently normal electrocardiogram results, those with new-onset or persistent ERP had increased risks of incident arrhythmias. In subjects with time-updated ERP, anterior leads and J wave amplitudes ≥0.2 mV were associated with a higher incidence of arrhythmias.Conclusions: Several types of ERP, including time-varying, time-updated, new-onset, and consistent, are associated with the incidence of arrhythmias in the middle-aged biracial (Black and White) population. |
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| AbstractList | Background: The early repolarization pattern (ERP) is associated with cardiovascular death, but its connection with arrhythmias remains unknown. This study evaluated relationships between ERP and incident arrhythmias, including ventricular arrhythmias, bradyarrhythmias, and atrial fibrillation (AF)/flutter (Afl).Methods and Results: We analyzed 14,679 middle-aged (45–64 years) participants from the Atherosclerosis Risk in Communities cohort, a prospective population-based study in the US. Participants were monitored for ERP status at baseline and at 3 subsequent follow-up visits. We examined associations between incident arrhythmias and baseline ERP, time-varying ERP, time-updated ERP, and changes in ERP over time using Cox models to estimate hazard ratios (HRs) adjusted for potential confounders. Over a 20-year follow-up, there were 1,252 ventricular arrhythmias, 890 bradyarrhythmias, and 2,202 cases of AF. Time-updated ERP was associated with increased HRs for ventricular arrhythmias (1.55; 95% confidence interval [CI] 1.35–1.77), bradyarrhythmias (1.76; 95% CI 1.48–2.08), and AF (1.25; 95% CI 1.10–1.43). Time-varying ERP also showed associations with these outcomes. Compared with individuals with consistently normal electrocardiogram results, those with new-onset or persistent ERP had increased risks of incident arrhythmias. In subjects with time-updated ERP, anterior leads and J wave amplitudes ≥0.2 mV were associated with a higher incidence of arrhythmias.Conclusions: Several types of ERP, including time-varying, time-updated, new-onset, and consistent, are associated with the incidence of arrhythmias in the middle-aged biracial (Black and White) population. The early repolarization pattern (ERP) is associated with cardiovascular death, but its connection with arrhythmias remains unknown. This study evaluated relationships between ERP and incident arrhythmias, including ventricular arrhythmias, bradyarrhythmias, and atrial fibrillation (AF)/flutter (Afl). We analyzed 14,679 middle-aged (45-64 years) participants from the Atherosclerosis Risk in Communities cohort, a prospective population-based study in the US. Participants were monitored for ERP status at baseline and at 3 subsequent follow-up visits. We examined associations between incident arrhythmias and baseline ERP, time-varying ERP, time-updated ERP, and changes in ERP over time using Cox models to estimate hazard ratios (HRs) adjusted for potential confounders. Over a 20-year follow-up, there were 1,252 ventricular arrhythmias, 890 bradyarrhythmias, and 2,202 cases of AF. Time-updated ERP was associated with increased HRs for ventricular arrhythmias (1.55; 95% confidence interval [CI] 1.35-1.77), bradyarrhythmias (1.76; 95% CI 1.48-2.08), and AF (1.25; 95% CI 1.10-1.43). Time-varying ERP also showed associations with these outcomes. Compared with individuals with consistently normal electrocardiogram results, those with new-onset or persistent ERP had increased risks of incident arrhythmias. In subjects with time-updated ERP, anterior leads and J wave amplitudes ≥0.2 mV were associated with a higher incidence of arrhythmias. Several types of ERP, including time-varying, time-updated, new-onset, and consistent, are associated with the incidence of arrhythmias in the middle-aged biracial (Black and White) population. The early repolarization pattern (ERP) is associated with cardiovascular death, but its connection with arrhythmias remains unknown. This study evaluated relationships between ERP and incident arrhythmias, including ventricular arrhythmias, bradyarrhythmias, and atrial fibrillation (AF)/flutter (Afl).BACKGROUNDThe early repolarization pattern (ERP) is associated with cardiovascular death, but its connection with arrhythmias remains unknown. This study evaluated relationships between ERP and incident arrhythmias, including ventricular arrhythmias, bradyarrhythmias, and atrial fibrillation (AF)/flutter (Afl).We analyzed 14,679 middle-aged (45-64 years) participants from the Atherosclerosis Risk in Communities cohort, a prospective population-based study in the US. Participants were monitored for ERP status at baseline and at 3 subsequent follow-up visits. We examined associations between incident arrhythmias and baseline ERP, time-varying ERP, time-updated ERP, and changes in ERP over time using Cox models to estimate hazard ratios (HRs) adjusted for potential confounders. Over a 20-year follow-up, there were 1,252 ventricular arrhythmias, 890 bradyarrhythmias, and 2,202 cases of AF. Time-updated ERP was associated with increased HRs for ventricular arrhythmias (1.55; 95% confidence interval [CI] 1.35-1.77), bradyarrhythmias (1.76; 95% CI 1.48-2.08), and AF (1.25; 95% CI 1.10-1.43). Time-varying ERP also showed associations with these outcomes. Compared with individuals with consistently normal electrocardiogram results, those with new-onset or persistent ERP had increased risks of incident arrhythmias. In subjects with time-updated ERP, anterior leads and J wave amplitudes ≥0.2 mV were associated with a higher incidence of arrhythmias.METHODS AND RESULTSWe analyzed 14,679 middle-aged (45-64 years) participants from the Atherosclerosis Risk in Communities cohort, a prospective population-based study in the US. Participants were monitored for ERP status at baseline and at 3 subsequent follow-up visits. We examined associations between incident arrhythmias and baseline ERP, time-varying ERP, time-updated ERP, and changes in ERP over time using Cox models to estimate hazard ratios (HRs) adjusted for potential confounders. Over a 20-year follow-up, there were 1,252 ventricular arrhythmias, 890 bradyarrhythmias, and 2,202 cases of AF. Time-updated ERP was associated with increased HRs for ventricular arrhythmias (1.55; 95% confidence interval [CI] 1.35-1.77), bradyarrhythmias (1.76; 95% CI 1.48-2.08), and AF (1.25; 95% CI 1.10-1.43). Time-varying ERP also showed associations with these outcomes. Compared with individuals with consistently normal electrocardiogram results, those with new-onset or persistent ERP had increased risks of incident arrhythmias. In subjects with time-updated ERP, anterior leads and J wave amplitudes ≥0.2 mV were associated with a higher incidence of arrhythmias.Several types of ERP, including time-varying, time-updated, new-onset, and consistent, are associated with the incidence of arrhythmias in the middle-aged biracial (Black and White) population.CONCLUSIONSSeveral types of ERP, including time-varying, time-updated, new-onset, and consistent, are associated with the incidence of arrhythmias in the middle-aged biracial (Black and White) population. |
| ArticleNumber | CJ-24-0964 |
| Author | Lin, Mei-Ping Cheng, Yun-Jiu Chen, Zi-En Wu, Shu-Lin Liao, Yi-Jian Wu, Qian Huang, Min-Jing Zhou, Hai-Ling Xue, Yu-Mei Chen, Yan-Lin Lu, Si-Long Fang, Xian-Hong He, Qian Wang, Jin-Jie |
| Author_xml | – sequence: 1 fullname: He, Qian organization: Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University – sequence: 2 fullname: Liao, Yi-Jian organization: The First Clinical Medical College, Guangdong Medical University – sequence: 3 fullname: Wang, Jin-Jie organization: Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University – sequence: 4 fullname: Chen, Yan-Lin organization: Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University – sequence: 5 fullname: Huang, Min-Jing organization: Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University – sequence: 6 fullname: Lin, Mei-Ping organization: Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University – sequence: 7 fullname: Zhou, Hai-Ling organization: Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University – sequence: 8 fullname: Chen, Zi-En organization: Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University – sequence: 9 fullname: Wu, Qian organization: Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University – sequence: 10 fullname: Lu, Si-Long organization: Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University – sequence: 11 fullname: Wu, Shu-Lin organization: Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University – sequence: 12 fullname: Xue, Yu-Mei organization: Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University – sequence: 13 fullname: Fang, Xian-Hong organization: Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University – sequence: 14 fullname: Cheng, Yun-Jiu organization: Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University |
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| Cites_doi | 10.1161/CIR.0000000000000388 10.1161/CIRCULATIONAHA.111.047191 10.1056/NEJMoa0907589 10.1016/j.jacc.2012.11.053 10.1186/s12872-024-04163-9 10.1093/eurheartj/ehr264 10.1016/j.jelectrocard.2014.10.006 10.1016/j.hrthm.2009.12.006 10.1016/j.hrthm.2012.06.008 10.1161/CIRCEP.111.963983 10.1093/europace/eus150 10.1016/j.amjmed.2014.06.017 10.1016/j.jacc.2014.03.056 10.1016/j.jacc.2015.05.033 10.1161/JAHA.121.020776 10.1177/2047487315591442 10.1161/CIRCEP.119.007390 10.1253/circj.CJ-23-0926 10.1093/oxfordjournals.aje.a115184 10.1172/jci.insight.131156 10.1161/CIRCEP.113.000874 10.1093/eurjpc/zwad357 10.1093/europace/eus421 10.1093/europace/euv281 10.1111/jce.13848 10.1093/europace/euv301 10.1016/j.hrthm.2023.02.029 10.1016/j.jacc.2021.04.035 10.1016/S0735-1097(84)80433-7 10.1016/j.hrthm.2014.05.024 10.1001/jamanetworkopen.2023.42831 10.1016/j.hrthm.2016.11.027 10.1016/j.jacc.2012.11.023 10.1016/j.jacc.2013.07.015 10.1253/circj.CJ-22-0827 10.1161/CIRCULATIONAHA.118.039022 10.1161/CIRCULATIONAHA.118.036553 10.1161/CIRCEP.118.006350 |
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| Keywords | Ventricular arrhythmias Electrocardiography Early repolarization Atrial fibrillation Bradyarrhythmias |
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| Snippet | Background: The early repolarization pattern (ERP) is associated with cardiovascular death, but its connection with arrhythmias remains unknown. This study... The early repolarization pattern (ERP) is associated with cardiovascular death, but its connection with arrhythmias remains unknown. This study evaluated... |
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| SubjectTerms | Arrhythmias, Cardiac - epidemiology Arrhythmias, Cardiac - physiopathology Atherosclerosis - epidemiology Atherosclerosis - physiopathology Atrial fibrillation Atrial Fibrillation - epidemiology Atrial Fibrillation - physiopathology Bradyarrhythmias Bradycardia - epidemiology Bradycardia - physiopathology Early repolarization Electrocardiography Female Follow-Up Studies Humans Incidence Male Middle Aged Prospective Studies Risk Factors United States - epidemiology Ventricular arrhythmias |
| Title | Long-Term Risk of Incident Arrhythmias Associated With Early Repolarization Pattern ― The Atherosclerosis Risk in Communities (ARIC) Study |
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