Early repolarization pattern in competitive athletes: Clinical correlates and the effects of exercise training

Peter A. Noseworthy, Rory Weiner, Jonathan Kim, Varsha Keelara, Francis Wang, Brant Berkstresser, Malissa J. Wood, Thomas J. Wang, Michael H. Picard, Adolph M. Hutter, Christopher Newton-Cheh, Aaron L. Baggish

Research output: Contribution to journalArticlepeer-review

105 Scopus citations


Background-Inferior lead early repolarization pattern (ERP) recently has been associated with sudden cardiac death. Although ERP is common among athletes, prevalence, ECG lead distribution, clinical characteristics, and effects of physical training remain uncertain. We sought to examine the nonanterior ERP in competitive athletes. Methods and Results-ERP was assessed in a cross-sectional cohort of collegiate athletes (n=879). The relationship between ERP and cardiac structure were then examined in a longitudinal subgroup (n=146) before and after a 90-day period of exercise training. ERP was defined as J-point elevation ≥0.1 mV in at least 2 leads within a nonanterior territory (inferior [II, III, aVF] or lateral territory [I, aVL, V4-V6]). Nonanterior ERP was present in 25.1% (221/879) of athletes, including the inferior subtype in 3.8% (33/879). Exercise training led to significant increases in the prevalence of ERP and the inferior subtype, but there were no associations between ERP and echocardiographic measures of left ventricular remodeling. In a multivariable model, ERP was associated with black race (odds ratio [OR], 5.84; 95% CI, 3.54 to 9.61; P<0.001), increased QRS voltage (OR, 2.08; 95% CI, 1.71 to 2.52; P<0.001), and slower heart rate (OR, 1.54; 95% CI, 1.26 to 1.87; P<0.001). Conclusions-Nonanterior ERP, including the inferior subtype, is common and has strong clinical associations among competitive athletes. The finding of increased ERP prevalence after intense physical training establishes a strong association between exercise and ERP.

Original languageEnglish (US)
Pages (from-to)432-440
Number of pages9
JournalCirculation: Arrhythmia and Electrophysiology
Issue number4
StatePublished - Aug 2011


  • Electrocardiography
  • Electrophysiology
  • Exercise

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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