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Malignant early repolarization syndrome (MERS) has recently been recognized as a rare arryhthmogenic entity for sudden cardiac death. Once considered a benign finding on ECG, recent studies establish a link between the presence of early repolarization and idiopathic ventricular fibrillation (VF). This report describes a nocturnal presentation and subsequent treatment of MERS.
A seventy-year-old woman suffered VF arrest overnight. Adequately anticoagulated, her cardiac biomarkers, catheterization and echocardiography were unremarkable. The EKG revealed a J-wave elevation in five inferior-lateral leads(Figure 1), consistent with Type-3 MERS. The patient underwent implantation of a cardioverter defibrillator and was started on Ito-blockade with disopyramide. At two year follow up, there have been no recurrent episodes of VF and J-waves remain absent on ECG.
MERS is an uncommon cause of VF arrest. Although the literature suggests dynamic fluctuations in J-waves, night-time arrest is not a common association. This case suggests that the presence of the J-waves in multiple leads may be associated with a more ominous prognosis. MERS should be contemplated as the cause of unexplained VF arrest when other, more common etiologies have been excluded.