Dynamicity of the J-Wave in Idiopathic Ventricular Fibrillation With a Special Reference to Pause-Dependent Augmentation of the J-Wave

Aizawa, Yoshifusa; Sato, Akinori; Watanabe, Hiroshi; Chinushi, Masaomi; Furushima, Hiroshi; Horie, Minoru; Kaneko, Yoshiaki; Imaizumi, Tsutomu; Okubo, Kimie; Watanabe, Ichiro; Shinozaki, Tsuyoshi; Fukuda, Keiichi; Joo, Kunitake; Haı̈ssaguerre, Michel

doi:10.1016/j.jacc.2012.02.028

Cited by 108 publications

(72 citation statements)

References 41 publications

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“…We considered catheter ablation therapy targeting the VPCs, but we hesitated because there was no repeatability of the VPCs in the frequent Holter recordings. In another study by Aizawa, et al 6) and in our patient, the height of the J waves was highly dependent on the heart rate ( Figure 5). We estimated that an elevation of the J waves just before the VF was closely related to bradycardia.…”

Section: Discussionsupporting

confidence: 67%

Early-Morning Type Ventricular Fibrillation With J Wave

et al. 2015

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SummaryA 67-year-old man who had cardiopulmonary arrest (CPA) at home was admitted to our institution. His spontaneous circulation was restored by bystander cardiopulmonary resuscitation (CPR) performed by his wife and an automated external defibrillator (AED). J waves were observed in the inferior leads of an electrocardiogram. We performed an implantable cardioverter defibrillator (ICD) implantation. After the ICD implantation, appropriate shocks due to ventricular fibrillation (VF) were observed on interrogation of the ICD at a frequency of twice a month. Most VF events occurred in the early morning between 1:00 to 6:00, and ventricular premature contractions (VPCs) were detected just before the occurrence of VF. Since the VF events always occurred in the early morning, we started long-acting disopyramide (150 mg/day, before bedtime), which has a muscarinic receptor blocking action. As a result, he has not received any appropriate ICD shocks for more than two years. (Int Heart J 2015; 56: 459-461) Key words: Disopyramide, Idiopathic ventricular fibrillation, J wave syndrome, Implantable cardioverter defibrillator, Ventricular premature contraction V entricular fibrillation (VF) is an arrhythmia that causes sudden cardiac death and can easily occur in patients with structural heart disease. It is well known that VF may occur in patients with a normal heart and J waves on the 12-lead electrocardiogram (ECG). Some studies have reported that J waves on the 12-lead ECG are often detected in healthy subjects with VF events.1-3) In addition, coronary spastic angina (CSA) is also known as a heart disease that causes VF without any structural myocardial injury. Here we present a J wave syndrome patient who had frequent VF events in the early morning showing J waves in the inferior leads of the 12-lead ECG and the VF events were successfully cured by the oral administration of long-acting disopyramide. Case ReportA 67-year-old man who had cardiopulmonary arrest (CPA) at home was admitted to our institution. His spontaneous circulation had been restored by bystander cardiopulmonary resuscitation (CPR) performed by his wife with an automated external defibrillator (AED) (Figure 1). He had no history of previous cardiovascular or other major diseases. Structural heart disease was not detected by echocardiography, but J waves were observed in the inferior leads of the 12-lead ECG (Figure 2). In the 24-hour Holter ECG recording with 12 leads, a circadian variation of the J waves was observed. The J waves were augmented in a lower heart rate, particularly in the early morning. We performed a signal-averaged ECG, but ventricular late potentials were not detected in this case.Blood test results and chest X-rays were normal. In addition, he did not experience any syncopal episodes and did not have a family history of sudden cardiac death. We confirmed that no Brugada-like electrocardiogram pattern was detected using the class Ic antiarrhythmic drug pilsicainide. We performed an electrophysiological study and programmed stimu...

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Section: Discussionsupporting

confidence: 67%

Early-Morning Type Ventricular Fibrillation With J Wave

et al. 2015

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“…J-waves exhibited diurnal variability or bradycardia-dependent augmentation characteristics in patients with idiopathic VF (IVF), 5,6,12, 21 suggesting an association between autonomic nervous activity and the occurrence of VF. Although J-waves are not uncommon in the general population, circadian variations in their amplitude and their relationship with heart rate (HR) or autonomic nervous activity has not been fully investigated in healthy subjects.…”

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confidence: 99%

Comparison of Autonomic J-Wave Modulation in Patients With Idiopathic Ventricular Fibrillation and Control Subjects

Miyazaki

Nakagawa

Shin

et al. 2013

Circ J

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“…10 However, bradycardia-dependent augmentation was observed in 15 (55.6%) of the 27 IVF patients with J waves and was not observed in the remaining patients in response to a slowing of the heart rate. 11 The patients without demonstrable pause-dependent augmentation had smaller J waves at baseline compared with those with J-wave augmentation: 0.173±0.086 versus 0.391±0.126 mV, respectively. In this study, 2 patients without attenuation had smaller J waves than the other patients, although the difference was not significant: 0.13 versus 0.43±0.26 mV, respectively (P=0.064).…”

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confidence: 84%

Tachycardia-Induced J-Wave Changes in Patients With and Without Idiopathic Ventricular Fibrillation

Takatsuki

Nishiyama

Kimura

et al. 2017

Circ: Arrhythmia and Electrophysiology

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Among 48 patients diagnosed with J-wave-associated IVF, J waves were studied in 8 patients during atrial pacing. In 1 patient, © 2017 American Heart Association, Inc. Original Article Circ Arrhythm ElectrophysiolBackground-To know the underlying mechanisms of J waves, the response to atrial pacing was studied in patients with idiopathic ventricular fibrillation (IVF) and patients with non-IVF. Methods and Results-In 8 patients with IVF, the J-wave amplitude was measured before, during, and after atrial pacing.All patients had episodes of ventricular fibrillation without structural heart disease. The responses of J waves were compared with those of the 17 non-IVF control subjects who revealed J waves but no history of cardiac arrest and underwent electrophysiological study. The IVF patients were younger than the non-IVF patients (28±10 versus 52±14 years, respectively; P=0.002) and had larger J waves with more extensive distribution. J waves decreased from 0.35±0.26 to 0.22±0.23 mV (P=0.025) when the RR intervals were shortened from 782±88 to 573±162 ms (P=0.001). A decrease (≥0.05 mV) in the J-wave amplitude was observed in 6 of the 8 patients. In addition, 1 patient showed a distinct reduction of J waves in the unipolar epicardial leads. In contrast, J waves were augmented in the 17 non-IVF subjects from 0.27±0.09 to 0.38±0.10 mV (P<0.001): augmented in 9 and unchanged in the 8 subjects. The different response patterns of J waves to rapid pacing suggest different mechanisms: early repolarization in IVF patients and conduction delay in non-IVF patients. Conclusions-The Aizawa et al Different Mechanisms of J-Wave Genesisa pause-dependent augmentation was analyzed in earlier study. 12 As the entry criteria, all patients were admitted after experiencing cardiac arrest because of out-of-hospital VF and being resuscitated by emergency medical personnel. All of them showed normal findings in complete blood counts, blood chemistry panels, and serological tests after admission and echocardiography, and cardiac catheterization excluded structural heart diseases. A provocation test using acetylcholine or ergonovine maleate was negative for coronary spasms. Coexistence of Brugada syndrome was studied by Pilsicainide, a class Ic antiarrhythmic drug. All patients underwent atrial pacing during electrophysiological study (EPS) or at bedside to control VF. The atrial pacing was performed at steady rate at ≥1 peced cycle lengths. None was on any medication. Non-IVF PatientsAs a control group, the response of J waves to atrial pacing was also studied in 17 consecutive male subjects who presented with J waves among 220 patients who had undergone EPS in the preceding 2 years: 8 patients were common to the previous study, and 9 patients were new. 16The entry criteria were identical to those for the IVF patients, and none of the patients in the control group had a past history and a family history of sudden cardiac death or cardiac arrest. All patients denied having a history of structural heart disease, and they lacked the signs ...

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Dynamicity of the J-Wave in Idiopathic Ventricular Fibrillation With a Special Reference to Pause-Dependent Augmentation of the J-Wave

Abstract: Pause-dependent augmentation of J waves was confirmed in about one-half of the patients with idiopathic VF after sudden R-R prolongation. Such dynamicity of J waves was specific to idiopathic VF and may be used for risk stratification.

Cited by 108 publications

References 41 publications

Early-Morning Type Ventricular Fibrillation With J Wave

Early-Morning Type Ventricular Fibrillation With J Wave

Comparison of Autonomic J-Wave Modulation in Patients With Idiopathic Ventricular Fibrillation and Control Subjects

Tachycardia-Induced J-Wave Changes in Patients With and Without Idiopathic Ventricular Fibrillation

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