The electrocardiographic pattern of early repolarization (ER) is common, with a particularly high prevalence reported amongst athletes and adolescents. It has long been associated with benign outcome. Recently, an association between inferolateral ER pattern and sudden cardiac death (SCD) has been established by different groups. Population-based studies have also reported an increased mortality rate among patients with inferolateral ER pattern compared to controls. To bring back together these differences, it is important to focus on the definition of ER pattern used in these different studies as well as the population included. The definition of ER pattern associated with sudden cardiac death was the presence of J point elevation ≥0.1mV in at least 2 contiguous inferior and/or lateral leads of a standard 12-lead ECG and not ST elevation as it was often the case in the studies with benign outcome. Any study dealing with ER should clearly indicate the definition used. Otherwise it cannot be interpreted. Talking about definition, ER syndrome is an ER pattern (as defined above) associated with symptoms (syncope or aborted SCD) and/or familial history of SCD as mentioned in the last HRS/EHRA/APHRS Expert Consensus Statement on the Diagnosis and Management of Patients with Inherited Primary Arrhythmia Syndromes. It is important to recognise that having only an ER pattern is not a disease.
