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Early repolarization syndrome (ERS) is an idiopathic ventricular fibrillation (VF) associated with inferolateral J waves. While electrical storm (ES) in ERS is not rare, their characteristics and risk factors are not fully understood. This study aimed to clarify the significance of ES in ERS. We evaluated 44 patients with ERS who experienced VF/sudden cardiac death or arrhythmic syncope. We assessed clinical characteristics to identify the risk factors for ES. In total, 13 patients (30%) experienced ES (ES group). Of these, 11 patients (85%) experienced ES during the acute phase of initial VF episodes and 2 patients (2%) experienced ES during follow-up. VF associated with ES occurred during therapeutic hypothermia in 6 of 13 patients (46%). The J-wave voltage during therapeutic hypothermia was higher in the ES group than that in the patients without ES. Isoproterenol was used in 5 patients (38%), which decreased J-wave voltage and relieved ES. Among the clinical markers, shorter QT and QTp intervals (the interval from QRS onset to the peak of T wave), pilsicainide-induced ST elevation, and high scores on the Shanghai Score System were associated with ES. Although pilsicainide induced ST elevation in 6 of 34 patients (18%), spontaneous Brugada electrocardiographic patterns did not appear to be associated with VF. Therapeutic hypothermia was also a risk factor for acute phase ES. Patients with ERS in the ES group frequently had short QT and QTp intervals, pilsicainide-induced ST elevations, and high Shanghai Score System scores. Therapeutic hypothermia was also associated with acute phase ES. [Display omitted] [ABSTRACT FROM AUTHOR]

J waves in the inferior or lateral leads are characteristic electrocardiographic (ECG) changes in patients with early repolarization syndrome (ERS). However, the presence of J waves in the left posterior region has not yet been evaluated. The purpose of this study was to clarify the significance of J waves in the posterior left ventricle using leads V 7 –V 9 and a body surface mapping (BSM) system. Forty patients diagnosed with ERS were included. All patients exhibited J waves in either the contiguous inferior, lateral, or posterior leads. We evaluated the incidence of J waves in the inferolateral and posterior leads using a 15-lead ECG with synthesized V 7 –V 9 and an 87-lead BSM. Additionally, we assessed the arrhythmogenicity of the posterior regions based on the morphology of the premature ventricular complexes (PVCs) associated with ventricular fibrillation (VF). J waves were observed in the lateral, inferior, and posterior leads of 26 (65%), 31 (78%), and 39 (97%) patients, respectively. J waves were found only in the posterior leads of 5 patients. BSM was evaluated in 9 patients, all of whom exhibited a positive area on the posterior region. PVCs associated with VF were recorded in 5 patients. Among patients with inferolateral and posterior J waves, all except 1 patient who displayed left bundle branch block morphology showed PVCs originating from the posterior left ventricular region. Posterior J waves are common in ERS patients. This abnormality can be detected using leads V 7 –V 9 and the BSM system and may be associated with arrhythmogenesis. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose of review: To review data available in medical literature on the prognostic implications of the detection of an "early repolarization" (ER) pattern at standard electrocardiogram (ECG) in athletes, with particular reference to a possible increased risk of sudden death. Recent findings: In 2010, a case–control study of patients with vs. without idiopathic ventricular fibrillation in athletes found a higher prevalence of infero-lateral slurring J wave in cases than controls (28.6% vs. 7.6%; p = 0.006). Subsequently, a few studies assessed the prognostic value of the ER pattern (J point/ST-segment elevation with a typical ascending morphology and/or J wave with a notched morphology or with slurred QRS) in populations of athletes. Overall, a number of 3882 athletes were included in 5 studies, 1330 of whom (34.3%) had some evidence of ER pattern. No case of sudden death, as well as no increased risk of cardiovascular events, was reported in these studies. Summary: Our revision of population studies involving athletes in medical literature failed to find any apparent increase of the arrhythmic risk associated with ER/J wave, which, therefore, should be continued to be considered as benign findings on standard ECG. [ABSTRACT FROM AUTHOR]

Background: J‐waves may be observed during coronary angiography (CAG) or intracoronary acetylcholine (ACh) administration, but their significance is unknown. Methods: Forty‐nine patients, 59.1 ± 11.5 years old and 59% male, were studied on suspicion of vasospastic angina, and J wave dynamicity was compared between CAG and Ach administration. Results: Diagnostic (≥0.1 mV) or nondiagnostic (<0.1 mV) J waves in 9 and 3 patients, respectively, were augmented, and J waves were newly observed in 2 patients during CAG and Ach administration. Similar changes in the J‐wave amplitude were observed: from 0.10 ± 0.09 mV to 0.20 ± 0.15 mV (p <.002) and from 0.10 ± 0.10 mV to 0.20 ± 0.16 mV (p <.001) during CAG and Ach administration, respectively. J waves were located in the inferior leads and changed only during the right coronary interventions. In the remaining 35 patients, J waves were absent before and during the coronary interventions. Augmentation of J waves was found when the RR interval was shortened in some patients. Injection of anoxic media into the coronary artery might induce a conduction delay from myocardial ischemia that manifests as augmentation or new occurrence of J waves. Conclusions: Both CAG and intracoronary Ach administration affected J waves similarly in the same individuals. A myocardial ischemia‐induced conduction delay may be responsible for the changes in J waves, but further studies are needed. [ABSTRACT FROM AUTHOR]

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Abstract Background Earlier studies have shown male dominance of an early repolarization (ER) pattern and frequent coexistence with high Sokolow‐Lyon voltage. Although possible involvement of androgen is speculated, the underlying mechanism has not been clarified yet. Previous studies were conducted in adult populations or only in children, and there has been no study in which the ER pattern was investigated in a series of individuals ranging from children before puberty to adults. Methods We included 600 individuals comprising six groups according to age: 10–14 years old, 15–19 years old, twenties, thirties, forties, and fifties. Each group had 50 males and 50 females. The distribution of an ER pattern and related ECG parameters were assessed by age and gender. Results In early teenagers, there was no significant gender difference in the prevalence of an ER pattern (24% in men vs. 28% in women, p = .82). The prevalence of an ER pattern increased after puberty and reached a peak in men in their twenties (42%). With further advance of age, the prevalence of an ER pattern decreased. On the other hand, the prevalence of an ER pattern in women peaked at 28% in teenagers, and it decreased through twenties (20%) to thirties (10%). Similar male dominance after puberty was observed in Sokolow‐Lyon voltage and J‐point elevation but not in P‐wave amplitude. Conclusion The prevalence of an ER pattern, Sokolow‐Lyon voltage, and J‐point elevation are all augmented after puberty and decrease with aging, leading to frequent coexistence of these ECG findings in young men.

The presence of J waves in cases of ventricular fibrillation (VF) is known to be a risk for sudden cardiac death. Recently, the effectiveness of radiofrequency catheter ablation (RFCA) for early repolarization syndrome (ERS) has been reported. The patient is a 30-year-old male with elevated J waves of 0.1 mV in the inferior leads, who had previously developed VF and undergone implantable cardioverter defibrillator (ICD) implantation. Because the VF from short coupled premature ventricular contraction (PVC) was presented, the RFCA of the triggered PVC was attempted. But it was unsuccessful due to no inducibility of the triggered PVC. After that, despite anti-arrythmia drug treatment, appropriate ICD shock for VF was observed. Although we decided to do a second ablation and evaluated epicardial arrhythmia substrate, no specific findings of early repolarization syndrome were found in the electrophysiological study. Finally, we considered that the cause of VF was short-coupled variant of Torsade de Pointes, and PVC ablation was performed. VF has not occurred since. We consider that this is a rare case to evaluate the epicardial arrhythmogenic substrate of J wave. Ablation of the epicardial arrhythmogenic substrate in patients with early repolarization syndrome (ERS) has been shown to be effective, but the relationship between abnormal epicardial potentials and the pathophysiology is unclear. In this case, J-wave and epicardial delayed potentials were not considered to represent obvious arrhythmogenic substrates. Ablation of the triggered premature ventricular contraction may be effective in ERS without apparent abnormal potentials. [ABSTRACT FROM AUTHOR]

Abstract Background Certain cerebrovascular events can induce electrocardiography (ECG) abnormalities and cardiac dysfunction. The most frequent patterns reported are nonspecific ST-T change, inverted or broad T wave, prolongation of QT interval as well as ST-segment depression or elevation. Here we present a case of intracerebral hemorrhage (ICH) with transient J wave-like ST-segment elevation accompanied by myocardial lesion. Case presentation A 58-year-old woman was admitted to our hospital and diagnosed with right basal ganglia region cerebral hemorrhage. The ECG recorded on the second hospital day showed transient J wave-like ST-segment elevation accompanied by increased myocardial troponin I and myocardial enzyme. Conclusions The J wave-like ST-segment elevation may be not a specific ECG signs for primary ischemic heart diseases as it also could be found in ICH patients. We believe that the follow-up ECGs can be used in conjunction with repeated myocardial enzyme analysis and echocardiography to differentiate ICH-ralated J wave-like ST-segment elevation from acute myocardial infarction (AMI), thus avoiding unnecessary cardiac catheterization.

Background: Earlier studies have shown male dominance of an early repolarization (ER) pattern and frequent coexistence with high Sokolow‐Lyon voltage. Although possible involvement of androgen is speculated, the underlying mechanism has not been clarified yet. Previous studies were conducted in adult populations or only in children, and there has been no study in which the ER pattern was investigated in a series of individuals ranging from children before puberty to adults. Methods: We included 600 individuals comprising six groups according to age: 10–14 years old, 15–19 years old, twenties, thirties, forties, and fifties. Each group had 50 males and 50 females. The distribution of an ER pattern and related ECG parameters were assessed by age and gender. Results: In early teenagers, there was no significant gender difference in the prevalence of an ER pattern (24% in men vs. 28% in women, p =.82). The prevalence of an ER pattern increased after puberty and reached a peak in men in their twenties (42%). With further advance of age, the prevalence of an ER pattern decreased. On the other hand, the prevalence of an ER pattern in women peaked at 28% in teenagers, and it decreased through twenties (20%) to thirties (10%). Similar male dominance after puberty was observed in Sokolow‐Lyon voltage and J‐point elevation but not in P‐wave amplitude. Conclusion: The prevalence of an ER pattern, Sokolow‐Lyon voltage, and J‐point elevation are all augmented after puberty and decrease with aging, leading to frequent coexistence of these ECG findings in young men. [ABSTRACT FROM AUTHOR]

• Simulate J wave signals for dataset. • Convert 1D J wave to 2D grayscale images for pre-trained model input. • Use transfer learning with VGG16 for classification. The J wave in the electrocardiogram indicates that the patient may suffer from malignant arrhythmia, ventricular tachycardia and other diseases, and the probability of sudden death is greatly increased. Due to the low incidence of J wave syndrome, J wave data in public databases are scarce, which hinders the research progress of J wave detection. Therefore, this study aims to automatically identify J wave signals, construct relevant datasets, and combine transfer learning with the pre-trained VGG16 model to detect J wave signals. Given the limited availability of J wave data, we utilized a local transformation method to simulate the generation of J wave signals. Subsequently, the simulated J wave signals underwent a continuous wavelet transform, converting them into grayscale images suitable for input into the pre-trained network. Finally, we fine-tuned the VGG16 network structure, which was initially trained on ImageNet, and modified the network for binary classification output for J wave data training. According to experimental results, this method achieves a 99.34 % accuracy rate, 99.35 % sensitivity, and 99.32 % specificity for the identification of J wave data. The aforementioned results outperform existing J wave research methodologies, effectively facilitating the identification of J wave signals. [ABSTRACT FROM AUTHOR]

Background: Several signs of malignant early repolarizations have been proposed in patients with early repolarization syndrome (ERS). However, reports have challenged the efficacy of these signs in predicting future ventricular fibrillation (VF) in patients with ERS., Objective: This study aimed to assess the predictive value of various electrocardiogram (ECG) markers for future VF events in patients with ERS., Methods: We retrospectively evaluated the clinical characteristics of 44 patients with ERS to identify risk factors for VF during follow-up., Results: After the initial event, 16 patients experienced VF (VF group), whereas 28 did not (non-VF group). The VF group had a longer QRS interval, more fragmented QRS (fQRS), and a higher T/R voltage ratio than the non-VF group. Wide J waves were more prevalent in the VF group; however, other J-wave markers did not differ between the groups. Positive late potentials recorded on signal-averaged ECGs were more frequent in the VF group. Whereas none of the patients showed spontaneous Brugada syndrome on ECG, the VF group frequently exhibited pilsicainide-induced ST-segment elevation. These ECG markers were significantly associated with the occurrence of VF during follow-up. Patients with multiple ECG factors, including QRS abnormalities (wide QRS or fQRS), wide J waves, and a high T/R ratio, had a worse prognosis than patients without multiple factors, effectively stratifying patient risk., Conclusion: The occurrence of VF in patients with ERS may be associated with conduction abnormalities such as QRS widening, fQRS, high T/R ratio, positive late potentials, and pilsicainide test results. Therefore, ECG factors could be useful in identifying high-risk patients., Competing Interests: Disclosures H.M. and N.N. are affiliated with the endowed department by Japan Medtronic Inc., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background: Certain cerebrovascular events can induce electrocardiography (ECG) abnormalities and cardiac dysfunction. The most frequent patterns reported are nonspecific ST-T change, inverted or broad T wave, prolongation of QT interval as well as ST-segment depression or elevation. Here we present a case of intracerebral hemorrhage (ICH) with transient J wave-like ST-segment elevation accompanied by myocardial lesion.Case Presentation: A 58-year-old woman was admitted to our hospital and diagnosed with right basal ganglia region cerebral hemorrhage. The ECG recorded on the second hospital day showed transient J wave-like ST-segment elevation accompanied by increased myocardial troponin I and myocardial enzyme.Conclusions: The J wave-like ST-segment elevation may be not a specific ECG signs for primary ischemic heart diseases as it also could be found in ICH patients. We believe that the follow-up ECGs can be used in conjunction with repeated myocardial enzyme analysis and echocardiography to differentiate ICH-ralated J wave-like ST-segment elevation from acute myocardial infarction (AMI), thus avoiding unnecessary cardiac catheterization. [ABSTRACT FROM AUTHOR]

Background: Preoperative detection of high-/low-risk postoperative ventricular arrhythmia (POVA) patients using a noninvasive method is an important issue in the clinical setting. This study mainly aimed to determine the usefulness of several preoperative electrocardiographic (ECG) markers in the risk assessment of POVA with cardiac surgery. Method: We enrolled 1024 consecutive patients undergoing cardiac surgery, and a total of 823 patients were included in the study. Logistic regression analysis determined preoperative ECG markers. A new risk predicting model were developed to predict occurrence of POVA, and the receiver operating characteristic curve (ROC) was used to validate this model. Results: Of these, 337 patients experienced POVA, and 485 patients did not experience POVA in this retrospective study. Among 15 ECG markers, a univariate analysis found a strong association between POVA and preoperative VA, the R-wave in lead aVR, the QRS wave, index of cardiac electrophysiological balance (iCEB), QT interval corrected (QTc), Tpeak–Tend interval (Tpe) in lead V2, the J wave in the inferolateral leads, pathological Q wave, and SV1+RV5>35 mm. Multivariate analysis showed that a preoperative J wave [adjusted odds ratio (AOR): 3.80; 95% CI: 1.88–7.66; p < 0.001], Tpe >112.5-ms (AOR: 2.80; 95% CI: 1.57–4.99; p < 0.001), and SV1+RV5 >35 mm (AOR: 2.92; 95% CI: 1.29–6.60; p = 0.01) were independently associated with POVA. A new risk predicting model were developed in predicting POVA. Conclusion: The ECG biomarkers including J wave, Tpe >112.5 ms, and SV1+RV5 >35 mm were significantly predicted POVAs. A risk predicting model developed with electrocardiographic risk markers preoperatively predicted POVAs. [ABSTRACT FROM AUTHOR]

Background: Preoperative detection of high-/low-risk postoperative ventricular arrhythmia (POVA) patients using a noninvasive method is an important issue in the clinical setting. This study mainly aimed to determine the usefulness of several preoperative electrocardiographic (ECG) markers in the risk assessment of POVA with cardiac surgery.Method: We enrolled 1024 consecutive patients undergoing cardiac surgery, and a total of 823 patients were included in the study. Logistic regression analysis determined preoperative ECG markers. A new risk predicting model were developed to predict occurrence of POVA, and the receiver operating characteristic curve (ROC) was used to validate this model.Results: Of these, 337 patients experienced POVA, and 485 patients did not experience POVA in this retrospective study. Among 15 ECG markers, a univariate analysis found a strong association between POVA and preoperative VA, the R-wave in lead aVR, the QRS wave, index of cardiac electrophysiological balance (iCEB), QT interval corrected (QTc), Tpeak–Tend interval (Tpe) in lead V2, the J wave in the inferolateral leads, pathological Q wave, and SV1+RV5>35 mm. Multivariate analysis showed that a preoperative J wave [adjusted odds ratio (AOR): 3.80; 95% CI: 1.88–7.66; p < 0.001], Tpe >112.5-ms (AOR: 2.80; 95% CI: 1.57–4.99; p < 0.001), and SV1+RV5 >35 mm (AOR: 2.92; 95% CI: 1.29–6.60; p = 0.01) were independently associated with POVA. A new risk predicting model were developed in predicting POVA.Conclusion: The ECG biomarkers including J wave, Tpe >112.5 ms, and SV1+RV5 >35 mm were significantly predicted POVAs. A risk predicting model developed with electrocardiographic risk markers preoperatively predicted POVAs.

Background The prognostic value of early repolarization pattern (ERP) remains controversial. We aim to test the hypothesis that temporal changes in ERP are associated with increased risks for sudden cardiac death (SCD) and cardiovascular death. Methods and Results A total of 14 679 middle‐aged participants from the prospective, population‐based cohort were included in this analysis, with ERP status recorded at baseline and during 3 follow‐up visits in the ARIC (Atherosclerosis Risk in Communities) study. We related baseline ERP, time‐varying ERP, and temporal changes in ERP to cardiovascular outcomes. Cox models were used to estimate the hazard ratios (HRs) adjusted for possible confounding factors. With a median follow‐up of 22.5 years, there were 5033 deaths, 1239 cardiovascular deaths, and 571 SCDs. Time‐varying ERP was associated with increased risks of SCD (HR, 1.59 [95% CI, 1.25–2.02]), cardiovascular death (HR, 1.70 [95% CI, 1.44–2.00]), and death from any cause (HR, 1.16 [95% CI, 1.05–1.27]). Baseline ERP was also associated with 3 outcomes. Compared with those with consistently normal ECG findings, subjects with new‐onset ERP or consistent ERP experienced increased risks of developing SCD and cardiovascular death. The time‐varying ERP in women, White subjects, and anterior leads and J‐wave amplitudes ≥0.2 mV appeared to indicate poorer cardiovascular outcomes. Conclusions Our findings suggest that baseline ERP, time‐varying ERP, new‐onset ERP, and consistent ERP were independent predictors of SCD and cardiovascular death in the middle‐aged biracial population. Repeated measurements of the ERP might improve its use as a risk indicator for SCD.

Abstract Background and objectives Takotsubo cardiomyopathy (TTC) occasionally causes life-threatening ventricular arrhythmia. J wave on surface electrocardiography (sECG) has also been associated with idiopathic ventricular fibrillation and cardiac events; therefore, we investigated whether the presence of J wave on sECG is a potential risk factor for ventricular arrhythmia in patients with TTC. Subjects and methods We performed a retrospective study in 79 patients who were diagnosed with TTC from 2010 to 2014. Among them, 20 (25.3%) were diagnosed with ventricular tachycardia (VT). The J wave on the sECG was defined as J point elevation manifested through QRS notching or slurring at least 1 mm above the baseline in at least two leads. Results A higher prevalence of ventricular tachycardia was observed in patients with J wave. The corrected QT interval (QTc) was significantly longer in the VT group than in the non-VT group. In a multivariate analysis, the presence of J wave appeared to be the only independent predictors of VT [Hazard Ratio (HR) 3.5, p = 0.019]. Conclusion Our results suggest that the presence of J wave on the sECG is significantly associated with VT, and appear to indicate that the presence of J wave is a strong and independent predictor of VT in patients with TTC.

AimsThe “early repolarization” (ER) pattern and J wave are frequent findings on standard ECG. Controversial data have recently been reported about their prognostic implications in healthy subjects, but no longitudinal prospective study specifically designed to investigate their long-term prognostic value has hitherto been published.Methods and ResultsWe prospectively enrolled 4,176 consecutive subjects with no evidence of cardiovascular disease who were referred for standard ECG recording for routine check-ups or pre-operative assessments for non-cardiovascular surgery. ECGs were prospectively assessed for the presence of ER/J wave. A 10-year follow-up was available for 3,937 patients (94.3%), 660 of whom (16.8%) showed ER/J wave whereas 3,277 did not. A total of 644 deaths occurred (16.3%), 116 (2.95%) of which were attributed to cardiovascular causes. Both total and cardiovascular mortality adjusted for clinical and laboratory variables did not differ significantly between patients with vs. without ER/J wave (HR 0.94; 95% CI 0.75–1.19; p = 0.63 and HR 0.61; 95% CI 0.31–1.21; p = 0.16, respectively). No significant association with total and cardiovascular mortality was also found in pre-specified analyses for ER and J wave alone, ER/J wave detected in specific ECG regions (i.e., inferior, lateral, precordial), and type of J wave (notched or slurred).ConclusionIn this specifically designed prospective study of individuals without any evidence of cardiovascular disease, we found no significant association of ER/J wave with the risk of the total as well as cardiovascular mortality during long-term follow-up.

Background: In patients with Brugada syndrome, myocardial fibrosis can be identified through epicardial biopsy or cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE). However, the myocardial alterations in patients with early repolarization syndrome (ERS) remain poorly elucidated., Objective: The objective of this study was to investigate the presence of myocardial fibrosis in patients with ERS by LGE in CMR., Methods: We retrospectively evaluated 20 patients with ERS, all of whom exhibited J waves in the contiguous 2 leads. The location of J waves was classified as in the septum (V 1 -V 2 ), anterior (V 3 -V 4 ), lateral (I, aVL, V 5 -V 6 ), inferior (II, III, aVF), or posterior (V 7 -V 9 ) regions. To compare the distribution of LGE on CMR imaging with J waves, sections on short-axis view of the left ventricle (LV) were categorized as located in the septum, anterior, lateral, inferior, and posterior regions., Results: Overall, 85% of ERS patients displayed LGE, which was more prevalent in the septum and posterior regions, followed by the inferior and lateral regions. The presence or absence of J waves and LGE coincided in 61% of LV areas, whereas discordance between the distributions of J waves and LGE was observed in 38%. LGE was most frequent in the septum (75%), where its reflection in J waves may be less robust. The appearance of LGE was not associated with symptoms, electrical storm, or ventricular fibrillation occurrence during follow-up., Conclusion: LGE is common in patients with ERS, and the distribution of J waves and LGE coincides in approximately 60% of LV areas., Competing Interests: Disclosure H.M. and N.N. are affiliated with a department endowed by Japan Medtronic Inc., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background: On surface electrocardiographic (ECGs), it is difficult to differentiate Ito‐mediated J waves, a repolarization phenomenon seen in J wave syndromes (JWS) from terminal QRS deflections that mimic J waves (pseudo J waves) in intraventricular conduction delay (IVCD), an abnormality in depolarization. We hypothesize that the difference between the "maximum QRS duration" inclusive of J point or terminal QRS deflections and the minimum QRS duration identified across a 12‐lead ECG is significantly larger in Ito‐mediated J waves, and can serve as a marker to make this distinction. Methods: A retrospective analysis was performed on adults with ECGs consisting of one of the four following manifestations: J waves associated with hypothermia and early repolarization, and pseudo J waves associated with right bundle branch block (RBBB) and non‐specific intraventricular conduction delay (NS‐IVCD). All ECGs were assessed individually and the maximum and minimum discrete QRS deflections on 12‐lead tracings, defined as "QRSmax" and QRSmin, were identified. The difference between "QRSmax" and QRSmin, designated as ∆QRS, was calculated and compared across the studied populations. Results: A total of 60 patients consisting of 15 patients in each arm were included in the study. ΔQRS was significantly larger in the hypothermia and early repolarization groups, compared to RBBB and NS‐IVCD (p <.0001), with the following mean ∆QRS: hypothermia 54.3 ± 13.7 ms, early repolarization pattern 47.3 ± 15.3 ms, RBBB 19.3 ± 6.5 ms, and NS‐IVCD 16.0 ± 6.6 ms. Conclusion: ∆QRS may serve as a reliable ECG parameter for distinguishing Ito‐mediated J waves from pseudo J waves produced by delayed intraventricular conduction. [ABSTRACT FROM AUTHOR]

Aims: J-wave syndrome in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) has been linked to an increased risk of ventricular arrhythmia. We investigated the significance of J waves with respect to substrate manifestations and ablation outcomes in patients with ARVC.Methods and Results: Forty-five patients with ARVC undergoing endocardial/epicardial mapping/ablation were studied. Patients were classified into two groups: 13 (28.9%) and 32 (71.1%) patients with and without J waves, respectively. The baseline characteristics, electrophysiological features, ventricular substrate, and recurrent ventricular tachycardia/fibrillation (VT/VF) were compared. Among the 13 patients with J waves, only the inferior J wave was observed. More ARVC patients with J waves fulfilled the major criteria of ventricular arrhythmias (76.9% vs. 21.9%, P = 0.003). Similar endocardial and epicardial substrate characteristics were observed between the two groups. However, patients with J waves had longer epicardial total activation time than those without (224.7 ± 29.9 vs. 200.8 ± 21.9 ms, P = 0.005). Concordance of latest endo/epicardial activation sites was observed in 29 (90.6%) patients without J waves and in none among those with J waves (P < 0.001). Complete elimination of endocardial/epicardial abnormal potentials resulted in the disappearance of the J wave in 8 of 13 (61.5%) patients. The VT/VF recurrences were not different between ARVC patients with and without J waves.Conclusion: The presence of J waves was associated with the discordance of endocardial/epicardial activation pattern in terms of transmural depolarization discrepancy in patients with ARVC. [ABSTRACT FROM AUTHOR]

The J wave has never been documented in the electrocardiogram (ECG) of cats presenting with hypertrophic cardiomyopathy (HCM). The present study aimed to describe the presence, morphology, amplitude, and duration of J waves in cats with HCM. It included 20 apparently healthy cats and 45 cats diagnosed with HCM based on clinical, echocardiographic, ECG, and radiographic examination. The cats were of different breeds (Persian: 40, domestic short hair: 21, Siamese: 4), ages (6.01 ± 4.34 years), sexes (male: 33, female: 32), and weights (3.30 ± 1.51 kg). The J wave was absent in the ECGs of the healthy population, but was detected in 29 out of 45 cats with HCM (63%). The J waves were observed at the QRS-ST junction in more than one limb lead of the ECG. Only positive deflections with an amplitude =0.05 mV were included, as measured by an ECG ruler in three consecutive heart cycles. The J waves were mainly present in leads II (n=20) and III (n=16), with amplitudes of 0.06 ± 0.02 and 0.08 ± 0.03 mV; their mean (± SD) duration was 0.16 ± 0.05 msec in lead II and 0.18 ± 0.05 msec in lead III. They occurred in both notched and slurred morphologies, with the latter being more common. In conclusion, J waves were a common finding in the ECGs of cats with HCM. [ABSTRACT FROM AUTHOR]

Abstract Introduction The significance of high precordial electrocardiograms in idiopathic ventricular fibrillation (IVF) is unknown. Method This study included 50 consecutive patients (48 men; age, 42 ± 18 years) who had spontaneous ventricular fibrillation not linked to structural heart disease and received implantable cardiac defibrillator therapy. IVF was diagnosed in 35 patients and Brugada syndrome was diagnosed in other 15 patients. Electrocardiograms in high intercostal space were compared between 35 patients with IVF and 105 age‐ and sex‐matched healthy controls (patient: control ratio, 1:3). Results The frequency of J point elevation ≥ 0.1 mV in the 4th intercostal spaces was similar between patients with IVF (14%) and healthy controls (7%). However, the frequency of J point elevation ≥ 0.1 mV in the 3rd intercostal space was higher in patients with IVF (40%) than controls (11%) (p

Introduction: The significance of high precordial electrocardiograms in idiopathic ventricular fibrillation (IVF) is unknown.Method: This study included 50 consecutive patients (48 men; age, 42 ± 18 years) who had spontaneous ventricular fibrillation not linked to structural heart disease and received implantable cardiac defibrillator therapy. IVF was diagnosed in 35 patients and Brugada syndrome was diagnosed in other 15 patients. Electrocardiograms in high intercostal space were compared between 35 patients with IVF and 105 age- and sex-matched healthy controls (patient: control ratio, 1:3).Results: The frequency of J point elevation ≥ 0.1 mV in the 4th intercostal spaces was similar between patients with IVF (14%) and healthy controls (7%). However, the frequency of J point elevation ≥ 0.1 mV in the 3rd intercostal space was higher in patients with IVF (40%) than controls (11%) (p < .01). J point elevation was present only in the 3rd intercostal space but not in the 4th intercostal space in 30% of patients with IVF but only in 6% of controls (p < .01). During follow-up, the recurrence of ventricular fibrillation was higher in patients with IVF who had J point elevation in the 3rd intercostal space (36%) and Brugada syndrome(40%) than those with IVF who did not have J point elevation in the 3rd intercostal space(11%) (p < .05 for both).Conclusion: J point elevation in the 3rd intercostal space was associated with IVF and recurrences of ventricular fibrillation. Electrocardiogram recordings in the high intercostal space may be useful to identify risk of sudden death. [ABSTRACT FROM AUTHOR]

Background J waves are abnormal electrocardiogram findings that indicate an elevation at the junction between the QRS complex and the ST segment. Hypothermia is associated with fetal arrhythmia, along with the increase of J‐wave manifestation. Case Presentation A 68‐year‐old woman with a medical history of old cerebral infarction and dementia was admitted to the emergency department with accidental hypothermia. An admission, electrocardiogram (ECG) showed prominent J waves with the highest amplitude recorded in limb and precordial leads. Continuous ECG monitoring was recorded during the rewarming therapy. As the body temperature increased, the amplitude of J waves became lower and disappeared. This case clearly showed that the degree of core body temperature is related to the height of the J‐wave amplitude. There was no fatal arrhythmia during rewarming therapy. Conclusion This case describes serial changes in the J‐wave amplitude and morphology during rewarming therapy. Continuous ECG monitoring is important in a patient with severe hypothermia.

Background: The prognostic value of programmed electrical stimulation (PES) in Brugada syndrome (BrS) remains controversial. Asymptomatic BrS patients generally have a better prognosis than those with symptoms. The purpose of this study was to evaluate the value of nonaggressive PES with up to two extra stimuli and predict clinical factors for risk stratification in asymptomatic BrS patients. Methods: The study enrolled 193 consecutive asymptomatic BrS patients with type 1 ECG (mean age: 50 ± 13 years, 180 males) who underwent PES using a nonaggressive uniform protocol. Cardiac events (CEs: sudden cardiac death or ventricular tachyarrhythmia) during the follow‐up period were examined. Results: During a mean follow‐up of 101 ± 48 months, seven asymptomatic patients (3.6%) had a CE. The incidence of CEs was not different between patients with and without inducible ventricular tachyarrhythmia by PES (p =.51). The clinical significance of risk factor combinations, including spontaneous type 1 ECG, family history of sudden cardiac death, QRS duration in lead V2, and presence of J wave, was evaluated. Using the Kaplan–Meier method according to the number of risk factors, the prevalence of CE in patients with three or four risk factors was determined to be significantly higher than in those with one risk factor (p =.02 and p =.004, respectively). Conclusions: The present study suggests that inducibility of ventricular tachyarrhythmia does not predict future CEs in asymptomatic BrS patients. Combination analysis of the other four clinical risk parameters may be effective for risk assessment. [ABSTRACT FROM AUTHOR]

The 12-lead electrocardiographic findings in hypothermia include the presence of J waves; prolongation of the PR, QRS, and QT intervals; and atrial and ventricular dysrhythmias. Among these findings, the J wave, known as the Osborn wave, is considered pathognomonic. In 1953, the J wave was reported as a specific response to hypothermia in dogs, representing the current at the site of injury instead of a widening of the QRS complex that occurs caused by a conduction delay. The J wave is often accompanied by ventricular fibrillation. For the past 28 years, it was assumed that the hypothermia-induced J wave was mediated by the transient outward current. However, it was recently been reported that the J waves in some patients with hypothermia can be considered delayed conduction-related waveforms. Here, we present a case of hypothermia-induced J waves together with giant R waves, which have not been previously reported during hypothermia, augmented by short RR intervals arising from premature atrial contractions. Our observations indicate that the underlying mechanism for the genesis of J waves is indeed conduction delay and not transient outward currents., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Takahashi et al.)

Background: The mechanism underlying the occurrence of the J wave in low temperature remains unclear. However, low temperature is associated with metabolic disorder and 5' AMP‐activated protein kinase (AMPK), which modulates ionic currents and cardiac metabolism. This study investigated whether AMPK regulation can modulate the occurrence of the J wave at low temperature. Methods: Unipolar and bipolar leads were used to record monophasic action potential (the endocardium and epicardium) and pseudo‐electrocardiograms (inferior leads) to study the cardiac electrical activity. Measurements were taken in isolated Langendorff rabbit hearts at both 30℃ and 37℃ before and after administration of 4‐aminopyridine (an ultrarapid delayed rectifier potassium current inhibitor, IKur, 50 µmol L−1), PF06409577 (an AMPK activator, 1 µmol L−1), compound C (an AMPK inhibitor, 10 µmol L−1) and glibenclamide (an ATP‐sensitive inward rectifier potassium channel inhibitor, IKATP, 20 µmol L−1). Results: The amplitude of the J wave (2.46 ± 0.34 mV vs. 1.11 ± 0.23 mV, P <.01) at 30℃ (n = 15) was larger than that at 37℃ (n = 15). PF06409577 (1 µmol L−1) increased the J waves at both 30℃ and 37℃. In contrast, compound C (10 µmol L−1) reduced J wave at both 37℃ and 30℃. Low‐temperature‐induced J waves were individually suppressed by 4‐AP (50 µmol L−1) and glibenclamide (20 µmol L−1). Conclusions: AMPK inhibition reduces low‐temperature‐induced J waves and possible ventricular arrhythmogenesis by modulating IKATP and IKur channels. [ABSTRACT FROM AUTHOR]

Background: Inferolateral early repolarization (ER) is associated with an increase in arrhythmic risk, particularly in the presence of myocardial ischemia.Objective: The purpose of this study was to determine the effect of myocardial ischemia on ER.Methods: We retrospectively analyzed procedural electrocardiograms (ECGs) of patients with ER undergoing a controlled, 1-minute coronary balloon occlusion for collateral function testing. ECG leads with ER were analyzed immediately before coronary balloon occlusion (PRE), at 60 seconds of coronary balloon occlusion (OCCL), and >30 seconds after balloon deflation.Results: Seventy-seven patients with ER in the preprocedural ECG (86% inferior, 20% lateral) underwent 135 coronary balloon occlusions during which a J wave was recorded in 224 leads (ER leads). From PRE to OCCL, ST-segment amplitude (ST) in the ER lead increased in 94 cases (44%) from 0.00 ± 0.03 to 0.05 ± 0.06 mV (P < .0001). In this group, J-wave amplitude (JWA) increased from 0.10 ± 0.07 to 0.13 ± 0.09 mV (P < .0001). ST in the ER lead decreased or was unchanged in 121 cases (56%) from PRE to OCCL (from 0.01 ± 0.05 to -0.02 ± 0.04 mV; P < .0001). In this group, JWA decreased from 0.10 ± 0.05 to 0.08 ± 0.07 mV (P < .0001). The change in JWA was related to the change in ST (linear regression analysis; R2 = 0.34; P < .0001), while there was no relation between the change in R-wave amplitude and the change in ST (R2 = 0.0003; P = .83).Conclusion: During acute ischemia, JWA mirrors ST-segment changes. This may explain increased arrhythmic vulnerability of patients with ER during myocardial ischemia. It also adds weight to the hypothesis of ER being a phenomenon of repolarization. [ABSTRACT FROM AUTHOR]

Background: Generally considered benign, electrocardiographic (ECG) early repolarization (ER) pattern was claimed to be an indicator of increased susceptibility to ventricular arrhythmias during acute ischemia.Objective: The purpose of this study was to assess in a nonselected population whether ER pattern documented before ST-elevation myocardial infarction (STEMI) is associated with risk of hemodynamically unstable ventricular tachycardia (VT) or ventricular fibrillation (VF) during acute STEMI.Methods: For STEMI patients admitted for primary percutaneous coronary intervention from 2007-2010, the latest ECGs recorded before STEMI were exported in digital format. After excluding ECGs with paced rhythm and QRS duration ≥120 ms, the remaining ECGs were processed using the Glasgow algorithm allowing automatic ER detection. The association between ER pattern and VT/VF during the first 48 hours of STEMI was tested using logistic regression.Results: ECGs recorded before STEMI were available for 1584 patients. Of these patients, 124 did not meet inclusion criteria, leaving 1460 patients available for analysis (age 68 ± 12 years; 67% male). ER pattern was present in 272 patients (18.6%; ER+ group). ER+ and ER- groups did not differ with regard to clinical characteristics. VT/VF during the first 48 hours of STEMI occurred in 19 ER+ (7.0%) and 105 ER- patients (8.8%; P = .398). ER was not associated with any VT/VF (odds ratio [OR] 0.78; 95% confidence interval [CI] 0.47-1.29; P = .324); VT/VF before reperfusion (OR 0.48; 95% CI 0.23-1.001; P = .051); or reperfusion-related VT/VF (OR 1.28; 95% CI 0.55-3.01; P = .569).Conclusion: In a nonselected population of STEMI patients, the ER pattern on ECG recorded before the acute coronary event was not associated with VT/VF during the first 48 hours of STEMI. [ABSTRACT FROM AUTHOR]

• Both early repolarization (ER) and atrial fibrillation (AF) are highly prevalent in Wolff-Parkinson-White syndrome (WPW). • Inferior-lead ER after ablation is associated with AF recurrence in WPW patients. • Additional pulmonary vein isolation might be considered in WPW patients with AF and ER. Both atrial fibrillation (AF) and early repolarization (ER) are highly prevalent in patients with Wolff–Parkinson–White (WPW) syndrome. We retrospectively identified 123 WPW patients with manifest accessory pathway (mAP) and 105 patients with concealed accessory pathways (cAP) who underwent successful ablation of the APs. AF history prior to the ablation was investigated. The presence of ER was evaluated from the 12-lead electrocardiograms performed both before and immediately after the ablation. Patients were further followed up for AF occurrence after the AP ablation. Compared with cAP patients, WPW patients presented with higher incidence of previous AF, as well as ER after the AP ablation. Compared with those without AF history, WPW patients with comorbid AF were more prone to presenting ER, especially in the inferior leads, after the mAP ablation. Regression analysis suggested that the post-ablation ER in the inferior leads was strongly associated with AF in WPW patients [OR = 5.85; 95% confidence interval (CI): 2.29–14.96], even after adjusting for age and left atrial diameter (OR = 5.14; 95% CI: 1.80–14.74). Moreover, post-ablation inferior-lead ER was predictive of AF recurrence after mAP ablation during the follow-up of 22.6 ± 11.1 months. In comparison, ER was correlated with neither AF history nor AF recurrence in patients undergoing cAP ablation. ER in the inferior leads after the mAP ablation is highly correlated with AF history and recurrence in WPW patients. [ABSTRACT FROM AUTHOR]

Objective: Limited data are currently available regarding the long-term prognosis of patients with J-wave syndrome (JWS). The aim of this study was to investigate the long-term prognosis of patients with JWS and identify predictors of the recurrence of ventricular fibrillation (VF).Methods: This was a multicentre retrospective study (seven Japanese hospitals) involving 134 patients with JWS (Brugada syndrome (BrS): 85; early repolarisation syndrome (ERS): 49) treated with an implantable cardioverter defibrillator. All patients had a history of VF. All patients with ERS underwent drug provocation testing with standard and high intercostal ECG recordings to rule out BrS. The impact of global J waves (type 1 ECG or anterior J waves and inferolateral J waves in two or more leads) on the prognosis was evaluated.Results: During the 91±66 months of the follow-up period, 52 (39%) patients (BrS: 37; ERS: 15) experienced recurrence of VF. Patients with BrS and ERS with global J waves showed a significantly higher incidence of VF recurrence than those without (BrS: log-rank, p=0.014; ERS: log-rank, p=0.0009). The presence of global J waves was a predictor of VF recurrence in patients with JWS (HR: 2.16, 95% CI 1.21 to 3.91, p=0.0095), while previously reported high-risk electrocardiographic parameters (high-amplitude J waves ≥0.2 mV and J waves associated with a horizontal or descending ST segment) were not predictive of VF recurrence.Conclusions: This multicentre long-term study showed that the presence of global J waves was associated with a higher incidence of VF recurrence in patients with JWS. [ABSTRACT FROM AUTHOR]

Background: Early repolarization syndrome (ERS) is a rare but increasingly recognized cause of malignant ventricular arrhythmias.Objective: The purpose of this study was to characterize the presentations and treatments of ERS at our institution.Methods: We performed a retrospective chart review of all patients presenting to our institution between 2008 and 2019 with ERS. Exclusion criteria included Brugada syndrome, positive provocative testing with class I antiarrhythmic drugs, metabolic disturbances, or structural heart disease.Results: Of 10 patients identified with ERS, 8 were men with a mean age of 30 ± 17 years at diagnosis. Documented arrhythmias included ventricular fibrillation in 7 of 10, polymorphic ventricular tachycardia in 3 of 10, and monomorphic ventricular tachycardia in 3 of 10 patients. Atrial fibrillation was diagnosed in 3 of 10, and atrioventricular block was seen in 2 of 10. J waves and/or electrocardiographic early repolarization patterns were dynamic in 7 of 10. Arrhythmias occurred at rest in 8 of 10 and with exertion in 2 of 10. Only 1 patient had a family history of sudden death, and 4 of 10 patients had variants of uncertain significance on genetic testing. Quinidine effectively suppressed arrhythmias in 5 of 5 patients but required dose escalation to >1 g/d in 3 of 5 patients. Abnormal epicardial electrograms were recorded over the inferolateral left ventricle in 2 patients who underwent mapping and were successfully ablated. Premature ventricular contraction triggers were also targeted for ablation in 3 patients.Conclusion: ERS is a heterogeneous condition and may be associated with both atrial and ventricular arrhythmias, atrioventricular block, dynamic electrocardiographic changes, and variable triggers. In addition to targeting premature ventricular contraction triggers, mapping and ablation of abnormal epicardial electrograms may be a potential future treatment strategy. [ABSTRACT FROM AUTHOR]

A 50-year-old man was admitted to our hospital with hypotension and bradycardia after receiving high doses of atenolol, amlodipine, and etizolam. He had a drug-induced J wave on electrocardiography and subsequently underwent cardiac arrest. The patient was successfully rescued by venoarterial extracorporeal membrane oxygenation (VA-ECMO) and a good neurological outcome was achieved with therapeutic hypothermia (TH). In patients with J waves, TH is thought to increase the J waves and cause fatal arrhythmias, but in this case, rapid cooling with VA-ECMO allowed the patient to successfully complete TH.

Clinical studies have shown that J wave can he used as a high risk early warning index of some heart diseases. In view of the shortcomings of J wave diagnosis only by the clinicians’ experiences, which can easily lead to misdiagnosis. From the perspective of signal processing, this paper proposed a J wave automatic identification method. This method extracted the energy features of electrocardiogram data after the extreme-point symmetric mode decomposition and higher order statistics, combined linear and nonlinear features,and adopted the principal component analysis to reduce the dimension of the features. Finally.it used support vector machine optimized by artificial bee colony algorithm to realize automatic identification of J wave. The experimental results show' that the average accuracy rate of identifying J wrave is 97. 3% .which can effectively identify the J wave. [ABSTRACT FROM AUTHOR]

Highlights • The incidence of ventricular arrhythmia (VA) in acute myocardial infarction (AMI) patients has some precipitating factors. • J wave in AMI patients is a poor prognostic factor. • The locations of J wave are related to outcome of VA. • Inferior or lateral J wave resulted in higher risk of mortality. Abstract Background J wave syndrome and myocardial ischemia are related with malignant ventricular arrhythmia (VA). The characteristics of dynamic J wave in patients with early phase of acute myocardial infarction (AMI) and subsequent VA or electrical storm (ES) have not been well evaluated. Objective We investigated the utility of J wave in the prediction of VA and ES in patients within the early phase of AMI. Methods This study retrospectively enrolled 208 patients (mean age 69 ± 15 years, 171 males) with AMI. Of them, 50 patients had experienced VA during hospitalization and 24 had ES. The clinical and electrocardiographic characteristics of these patients with and without VA were compared. Results Patients with VA had a higher incidence of chronic kidney disease (CKD) and J wave compared with those without VA. The hazard ratio (HR) of J wave for VA was 4.31 (p < 0.01) and CKD was 2.64 (p < 0.01). In the VA group, ES patients had a higher incidence of diabetes mellitus (DM) (HR 2.73, p = 0.02) and J wave (HR 4.21, p < 0.01). If the AMI patients had J wave, the OR for mortality was 2.14 (p = 0.03), VA events was 6.23 (p < 0.01), and ES events was 12.15 (p < 0.01). If VA patients had J wave, the mortality rate will significantly increase (OR 68.62, p = 0.01). Conclusion The AMI patients who develop VA in the early phase of AMI had a higher incidence of J wave and CKD, and those who develop ES had a higher incidence of J wave and DM. It seems that J wave in AMI patients is a poor prognostic factor, and we found that J wave will increase mortality, VA events, and ES events. The majority locations of J wave were inferior leads although there was no relationship between the locations and VA incidence. If the VA patients had inferior or lateral J wave, it would further increase the risk of mortality. [ABSTRACT FROM AUTHOR]

A 51-year-old man with a resuscitation episode was referred to our hospital. Coronary angiography revealed a focal spasm overlapped with organic stenosis where a bare metal stent was implanted. Acetylcholine (ACh) provocation test did not induce chest pain. It revealed no discernible ST-T changes but unmasked a J wave at the end of the QRS complex, which was associated with short-coupled repetitive premature ventricular beats. A J wave reportedly appears immediately before the onset of ventricular fibrillation caused by vasospastic angina. However, a J wave observed newly after a coronary spasm provocation test using ACh without ST-T changes is informative when considering the mechanisms of the J wave.

An early repolarization pattern can be observed in 1% up to 13% of the overall population. Whereas, this pattern was associated with a benign outcome for many years, several more recent studies demonstrated an association between early repolarization and sudden cardiac death, so-called early repolarization syndrome. In early repolarization syndrome patients, current imbalances between epi- and endo-cardial layers result in dispersion of de- and repolarization. As a consequence, J waves or ST segment elevations can be observed on these patients' surface ECGs as manifestations of those current imbalances. Whereas, an early repolarization pattern is relatively frequently found on surface ECGs in the overall population, the majority of individuals presenting with an early repolarization pattern will remain asymptomatic and the isolated presence of an early repolarization pattern does not require further intervention. The mismatch between frequently found early repolarization patterns in the overall population, low incidences of sudden cardiac deaths related to early repolarization syndrome, but fatal, grave consequences in affected patients remains a clinical challenge. More precise tools for risk stratification and identification of this minority of patients, who will experience events, remain a clinical need. This review summarizes the epidemiologic, pathophysiologic and diagnostic background and presents therapeutic options of early repolarization syndrome.

Objective To investigate the predictive value of J wave in different leads( inferior wall, anterior wall and lateral wall) for tlie occurrence of short-term ventricular fibrillation( VF) among the patients with acute ST-segment elevation myocardial infarction ( A STEM I). Methods Retrospective analysis was performed on 588 patients definitely diagnosed with ASTEMI in our hospital from January 2014 to January 2017. These patients were divided into VF group( 38 cases) and non-VF group! 550 cases I liased on whether VF appeared on their ECGs. Basic clinical data (gender, age, history of smoking, hypertension, diabetes or dyslipidemia) and level of myocardial markers(CK, CK-MB and troponin) were compared between these two groups. VF group was further divided into inferior wall, anterior wall and lateral wall groups. The relativity between ischemic J wave in different leads and the occurrence of VF was analyzed-Results ( j ) Tliere was no statistically significant difference in the basic clinical data and level of myocardial markers between VF and non-VF groups( P >0.05 ). ( jj ) In the VF group, J wave in inferior wall leads was observed in 23 cases! 60. 53% i . J wave in anterior wall leads was observed in 10 cases(26.32% ), and J wave in lateral wall leads was observed in 5 cases(13. 16% ). Among those patients with inferior wall myocardial infarction. 16(42. 11% ) were complicated by right ventricular myocardial infarction. According to ROC curve, for patients with J wave in different leads, the order of VF incidence from high to low was that of patients with J wave in inferior wall leads, anterior wall leads and lateral wall leads, with statistically significant differences! P < 0. 05 ). Conclusion The appearance of J waves in different infarction sites indicates different incidences of VF. The order of VF incidence from high to low was that of patients with J wave in inferior wall leads. anterior wall leads and lateral wall leads. There will he a significant increase of VF incidence within a short time period if J wave appears in inferior wall and right ventricular leads. J wave in different leads can serve as a warning sign of VF and sudden death. [ABSTRACT FROM AUTHOR]

Abstract: Background: Variant angina (VA) is caused by reversible coronary artery spasm, which is characterized by chest pain with ST segment elevations on a standard 12‐lead electrocardiogram (ECG) at rest. VA attack often causes lethal ventricular arrhythmia. The early repolarization (ER) pattern is associated with ventricular fibrillation (VF). However, whether the ER pattern is involved in VF in patients with VA is not known. We investigated the association between the ER pattern and VF in patients with VA. Methods: Fifty patients underwent induction of ST elevation on 12‐lead ECGs with total or nearly total occlusion by provocation test (VA patients). Twelve of these patients underwent induction of VF or had documented VF before hospital admission (VF occurrence group). The J‐wave morphology was characterized as exhibiting notching or slurring. The amplitude of each J wave was measured manually with amplified waveforms. Results: ER patterns were observed significantly more often in the VF occurrence group than in the non‐VF occurrence group (P = 0.007). The J‐wave amplitude was significantly higher in the VF occurrence group compared with the non‐VF occurrence group (P = 0.02). Univariate analyses suggested that age, smoking, and ER patterns were associated with VF. Upon multivariate analyses, age (odds ratio [OR] = 0.880; 95% confidence interval [CI]: 0.794–0.975; P = 0.014) and ER patterns (OR = 8.937; 95% CI:1.661–48.06; P = 0.011) predicted VF independently. Conclusions: These data suggest that an ER pattern in VA patients is a risk factor for VF. The ER pattern may be one of the useful factors for adaptation of implantation of implantable cardioverter‐defibrillator in patients with coronary spasm‐induced VF. [ABSTRACT FROM AUTHOR]

Introduction: Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome characterized by ST-segment elevation in right precordial ECG leads and associated with sudden cardiac death in young adults. The ECG manifestations of BrS are often concealed but can be unmasked by sodium channel blockers and fever. Areas covered: Implantation of a cardioverter defibrillator (ICD) is first-line therapy for BrS patients presenting with prior cardiac arrest or documented VT. A pharmacological approach to therapy is recommended in cases of electrical storm, as an adjunct to ICD and as preventative therapy. The goal of pharmacological therapy is to produce an inward shift to counter the genetically-induced outward shift of ion channel current flowing during the early phases of the ventricular epicardial action potential. This is accomplished by augmentation of ICa using □□adrenergic agents or phosphodiesterase III inhibitors or via inhibition of Ito. Radiofrequency ablation of the right ventricular outward flow tract epicardium is effective in suppressing arrhythmogenesis in BrS patients experiencing frequent appropriate ICD-shocks. Expert commentary: Understanding of the pathophysiology and approach to therapy of BrS has advanced considerably in recent years, but there remains an urgent need for development of cardio-selective and ion-channel-specific Ito blockers for treatment of BrS. [ABSTRACT FROM AUTHOR]