Early repolarization (ER) is a common electrocardiographic pattern, characterized by J point and ST-segment elevation with upper concavity with tall symmetrical notched T waves in ≥2 contiguous leads, more commonly the precordial leads. The prevalence of ER in the general population ranges from 1% to 13%. It is also reported in 10% to 70% of patients with idiopathic ventricular fibrillation (VF). Over the past several decades ER has been considered a benign phenomenon. However, recently there have been several reports demonstrating the potential arrhythmogenicity of ER. Haïssaguerre et al observed that there was a higher incidence of recurrent VF in patients with ER (hazard ratio 2.1, 95% confidence interval 1.2 to 3.5, p = 0.008). More recently, Tikkanen et al reported that ER in the inferior leads was associated with an increased risk for cardiac death by J point elevation of 0.1 mV (relative risk 1.28, 95% confidence interval 1.04 to 1.59, p = 0.03) and an augmented risk for death from life-threatening ventricular arrhythmias (LTVAs) by J point elevation of >0.2 mV (relative risk 2.92, 95% confidence interval 1.45 to 5.89, p = 0.001) in the general population. Similarly, Rosso et al reported that ER was more common in patients with idiopathic VF. Studies have shown that a few patients with ER have LTVAs, and it is needless to say that careful attention should be paid to those subjects at risk. An important question is how to differentiate “high-risk” ER from so-called benign ER. Unfortunately, there currently are no data on ways to risk-stratify these patients. Another hypothesis is ER may exist as a continuous spectrum of disease (with a benign presentation at 1 end and LTVA at the other). Genetic contributions to sudden cardiac death–associated ER are suggested by common familial sudden death histories in symptomatic ER patients. Given the evidence so far, the question remains as to whether it would be appropriate to conclude that ER is not a benign finding. All reports of ER with idiopathic VF have used different definitions for ER and lack uniformity. Because there is a paucity of information on the characteristics of patients with “high-risk” ER it is inappropriate to change current practice in patients with ER. For now, asymptomatic patients with ER can be reassured that the available evidence indicates no increased risk. However, careful evaluation of patients with ER associated with unexplained syncope, family history of sudden cardiac death, or idiopathic LTVA is warranted.