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A response by Heikki V. Huikuri and Jani T. Tikkanen to a letter to the editor about their article "Long-term Outcome Associated With Early Repolarization on Electrocardiography," by J. T. Tikkanen et al. in the December 24, 2009 issue is presented.

A response by Heikki V. Huikuri and colleagues to several letters to the editor about their article "Sudden Death Due to Cardiac Arrhythmias" in the November 15, 2001 issue is presented.

Focuses on sudden death due to cardiac arrhythmias. Rates of death from cardiovascular causes in developed countries; Mechanisms of sudden death from arrhythmia, including ventricular tachycardia degeneration; Epidemiology; Risk factors, including cardiovascular dysfunction and ambient ventricular arrhythmias; Prevention.

Background: Early repolarization, which is characterized by an elevation of the QRS–ST junction (J point) in leads other than V1 through V3 on 12-lead electrocardiography, has been associated with vulnerability to ventricular fibrillation, but little is known about the prognostic significance of this pattern in the general population. Methods: We assessed the prevalence and prognostic significance of early repolarization on 12-lead electrocardiography in a community-based general population of 10,864 middle-aged subjects (mean [±SD] age, 44±8 years). The primary end point was death from cardiac causes, and secondary end points were death from any cause and death from arrhythmia during a mean follow-up of 30±11 years. Early repolarization was stratified according to the degree of J-point elevation (=0.1 mV or >0.2 mV) in either inferior or lateral leads. Results: The early-repolarization pattern of 0.1 mV or more was present in 630 subjects (5.8%): 384 (3.5%) in inferior leads and 262 (2.4%) in lateral leads, with elevations in both leads in 16 subjects (0.1%). J-point elevation of at least 0.1 mV in inferior leads was associated with an increased risk of death from cardiac causes (adjusted relative risk, 1.28; 95% confidence interval [CI], 1.04 to 1.59; P=0.03); 36 subjects (0.3%) with J-point elevation of more than 0.2 mV in inferior leads had a markedly elevated risk of death from cardiac causes (adjusted relative risk, 2.98; 95% CI, 1.85 to 4.92; P<0.001) and from arrhythmia (adjusted relative risk, 2.92; 95% CI, 1.45 to 5.89; P=0.01). Other electrocardiographic risk markers, such as a prolonged QT interval corrected for heart rate (P=0.03) and left ventricular hypertrophy (P=0.004), were weaker predictors of the primary end point. Conclusions: An early-repolarization pattern in the inferior leads of a standard electrocardiogram is associated with an increased risk of death from cardiac causes in middle-aged subjects. N Engl J Med 2009;361:2529-37. [ABSTRACT FROM AUTHOR]