ECG education

Benign early repolarisation: a normal ECG variation

Vivienne Miller



Emmanuel, aged 35 years, comes to see you, his GP, because he has been declined insurance until he obtains a cardiology review as his ECG has been considered abnormal. He works part time as a bouncer and is a very muscular, well built, tall (188 cm), healthy man, who is originally from Nigeria. He takes no medications and has no past or family history of relevance. He shows you the ECG and asks you what the problem could be.

Key Points

  • Benign early repolarisation is hypothesised to be due to early repolarisation after slowed depolarisation of the action potential. It is a normal variation.
  • Benign early repolarisation is typically seen in healthy muscular young men, those under the age of 50 years, and especially in people of Indigenous African descent.
  • People of Indigenous African descent also often have T wave inversion in the praecordial leads and this is of no significance unless they are in leads V5 and V6 (which is always abnormal).
  • People with thin chest walls and reduced subcutaneous fat over the chest may appear to have high voltage on the ECG.
  • Right bundle branch block is common in children and is rarely of consequence.
  • Incomplete right bundle branch block is common and usually a normal finding but may be associated with underlying pathology.
  • Incorrect settings on the ECG machine may mimic abnormalities.
  • Diagnoses from ECG machines are not always correct and may overdiagnose or miss abnormalities, especially variations of normal.