Benign Early Repolarization Phenomenon in Young Adults and Athletes: A Literature Review of Clinical Insights and Diagnostic Considerations.

Early repolarization (ER) is an electrocardiographic pattern characterized by J-point elevation and ST-segment changes, historically considered a benign finding, especially in young adults and athletes. This review explores the clinical relevance of ER, emphasizing its electrophysiological basis, demographic patterns, and implications for risk stratification. While ER frequently appears in healthy individuals, particularly those engaged in high-intensity training, certain morphological variants and dynamic patterns have been associated with an increased risk of life-threatening arrhythmias and sudden cardiac death (SCD). The prevalence of ER is notably higher in athletes, reflecting physiological adaptations to sustained physical activity rather than underlying pathology. However, in middle-aged individuals or those with a personal or family history of arrhythmias, time-varying ER may suggest a more arrhythmogenic substrate requiring closer surveillance. Electrocardiographic features such as horizontal ST segments, fragmented QRS complexes, or widespread J-point elevation may indicate a higher risk. Comprehensive diagnostic evaluation includes history-taking, physical examination, Holter monitoring, exercise testing, and, when indicated, advanced imaging or electrophysiological studies. Management strategies emphasize contextual interpretation, shared decision-making, and personalized follow-up, particularly in athletes.