Repolarization (ST-T,U) Abnormalities

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Author(s) I.A.C. van der Bilt
Moderator I.A.C. van der Bilt
some notes about authorship

Repolarization can be influenced by many factors, including electrolyte shifts, ischemia, structural heart disease (cardiomyopathy) and (recent) arrhythmias. Although T/U wave abnormalities are rarely specific for one disease, it can be useful to know which conditions can change repolarization.

  • Early repolarization (normal variant)
    Early repol.svg
  • Juvenile T waves (normal variant)
  • Nonspecific abnormality, ST segment and/or T wave
  • ST and/or T wave suggests ischemia
  • ST suggests injury
  • ST suggests ventricular aneurysm
  • Q-T interval prolonged
  • Prominent U waves
  • Cardiac Memory|Cardiac Memory

Early repolarization is a normal variant of the ST segment, seen in 2-5% of patients, especially young men. Early repolarization is characterized by elevation of the J point and the beginning of the ST segment as well as elevation of the ST segment itself[1]. The ST segment may be concave up (cup-like) or concave (dome-like). These findings are most often present in the middle chest leads V2-V5. Recently a different form of early repolarization has been associated with idiopathic ventricular fibrillation. This form is most often seen in lead II and consists of a 'hump' in the tail of the QRS complex, without ST elevation.


  1. Wellens HJ. Early repolarization revisited. N Engl J Med. 2008 May 8;358(19):2063-5. DOI:10.1056/NEJMe0801060 | PubMed ID:18463384 | HubMed [Wellens]
  2. Tikkanen JT, Anttonen O, Junttila MJ, Aro AL, Kerola T, Rissanen HA, Reunanen A, and Huikuri HV. Long-term outcome associated with early repolarization on electrocardiography. N Engl J Med. 2009 Dec 24;361(26):2529-37. DOI:10.1056/NEJMoa0907589 | PubMed ID:19917913 | HubMed [Tikkanen]

All Medline abstracts: PubMed | HubMed