Idiopathic Ventricular Fibrillation, Early Repolarization and Other J Wave-Related Ventricular Fibrillation Syndromes

Nam, Gi‐Byoung

doi:10.1253/circj.cj-12-1306

Cited by 29 publications

(18 citation statements)

References 68 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rolf et al 9 reported a patient with BS with a resting ECG intermittently displaying a saddleback type and coved type ECG pattern, which was masked when CRBBB occurred. A similar case of a BS patient was reported by Nam 24 in 2012. On some occasions, we might be able to unmask BS in patients with CRBBB.…”

Section: Proof Of Coexisting Bs With Crbbbsupporting

confidence: 78%

Brugada Syndrome Behind Complete Right Bundle-Branch Block

et al. 2013

View full text Add to dashboard Cite

V entricular fibrillation (VF) can occur in patients without structural heart diseases; when it does, it is called idiopathic VF.1,2 Among primary electric diseases, Brugada syndrome (BS) is characterized by unique ECG patterns of J/ ST/T waves.3 This ECG pattern has been shown to be associated with an increased risk of sudden cardiac death compared with control subjects, 4 and an ECG diagnosis of BS is very important for risk stratification. 5,6 Clinical Perspective on p 1054Recently, we observed a case in which the characteristic ECG phenotype of BS was unmasked by relief of complete right bundlebranch block (CRBBB); when CRBBB resolved spontaneously, the characteristic ECG pattern of BS was found to be underlying. 7A similar case was reported by others. [8][9][10] The goal of this study is to discuss patients with BS that were complicated by CRBBB and to present evidence for the presence of BS in CRBBB patients. Methods PatientsThe study consisted of 11 patients who had CRBBB with the diagnosis of BS.5 Structural heart diseases were excluded by ECG, transthoracic echocardiography, and cardiac catheterization. Coronary spasm was excluded as the cause of VF by provocation tests using acetylcholine or ergonovine maleate at catheterization. Definitions of CRBBB and BSCRBBB was defined as a late R (R′) wave presenting in V 1 or V 2 , with a slurred, wide S in leads I and V 5 /V 6 and with prolonged duration of QRS ≥120 milliseconds. 11,12 If CRBBB was seen on the baseline ECG, we divided the patients into 2 groups. One group consisted of the patients in whom ECG revealed BS and CRBBB occurred subsequently during the follow-up (n=7). The other group consisted of the patients who had CRBBB on the baseline ECG but in whom BS was diagnosed in the following situations (n=4). First, resolution of CRBBB resulted in normal ventricular conduction, in which the characteristic ECG pattern for BS could be seen. The resolution of Background-The characteristic ECG of Brugada syndrome (BS) can be masked by complete right bundle-branch block (CRBBB) and exposed by resolution of the block or pharmacological or pacing maneuvers. Methods and Results-The study consisted of 11 patients who had BS and CRBBB. BS was diagnosed before the development of CRBBB, on the resolution of CRBBB, or from new characteristic ST-segment changes that could be attributable to BS. Structural heart diseases were excluded, and coronary spasm was excluded on the basis of a provocation test at catheterization. In 7 patients, BS was diagnosed before the development of CRBBB. BS was diagnosed when CRBBB resolved spontaneously (n=1) or by right ventricular pacing (n=3). The precipitating cause for the spontaneous resolution of CRBBB, however, was not apparent. On repeated ECGs, new additional upward-convex ST-segment elevation was found in V 2 or V 3 in 3 patients. In 2 patients, new ST-segment elevation was induced by class I C drugs. The QRS duration was more prolonged in patients with BS and CRBBB compared with age-and sex-matched controls: 170±13 versus 14...

show abstract

Section: Proof Of Coexisting Bs With Crbbbsupporting

confidence: 78%

Brugada Syndrome Behind Complete Right Bundle-Branch Block

et al. 2013

View full text Add to dashboard Cite

show abstract

“…This difference in action potential activity leads to the development of a transmural voltage gradient that manifests as a prominent J wave on ECG. 15 This mechanism can lead to phase 2 reentry. Severe hypothermia may increase the transmural voltage gradient, resulting in a higher amplitude of J waves in more areas.…”

Section: Discussionmentioning

confidence: 99%

J Waves in Accidental Hypothermia

Higuchi

Takahashi

Kabeya

et al. 2014

Circ J

View full text Add to dashboard Cite

128HIGUCHI S et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp he J wave, also known as the Osborn wave, 1 is a positive deflection at the terminal part of the QRS complex. Although J waves are often observed in hypothermic patients, 2 few reports have revealed the relationship between the presence of J waves and body temperature (BT). The exact BT at which J waves develop in clinical settings has not yet been determined.The J wave is noted not only in hypothermia but also in some nonhypothermic conditions such as Brugada and early repolarization syndromes. The presence of J waves in such syndromes is related to the occurrence of ventricular fibrillation (VF), leading to sudden death. However, whether hypothermic patients with J waves are susceptible to fatal ventricular arrhythmia or ventricular tachycardia (VT)/VF remains undetermined. Indeed, some previous reports have shown that the incidence of VT/VF is unexpectedly low in hypothermic patients with J waves, varying from 0% to 2%. 3-5 The augmentation of J waves following a long R-R interval is reported to be a marker for VF 6,7 because the heterogeneity of membrane potentials is expressed as augmentation of J waves and can induce VF due to phase 2 reentry. 8 A previous report demonstrated that VF developed after sudden augmentation of J waves in idiopathic VF, which was induced following a long coupling interval. 6 Such an event in hypothermic patients would serve as a warning sign for identifying patients at high risk of developing VF.In the present study, we sought to clarify the relationship between the incidence of J waves and BT, as well as the clinical implications of J waves in patients with accidental hypothermia. We also attempted to determine the augmentation of J waves following a long R-R interval in patients with atrial fibrillation (AF). Methods Study DesignWe studied 64 consecutive patients who were admitted to hospital for accidental hypothermia between 2002 and 2012. Of these, 63 were homeless people admitted during the winter. The remaining patient was not homeless, but succumbed to hypothermia in a cold house because of depression. We reviewed all the patients' medical records to evaluate clinical characteristics such as age, sex, vital signs, cause of hypothermia, ECG findings, and laboratory data on admission. Hypothermia was defined as a rectal temperature <35.0°C.

show abstract

“…This ECG sign is, however, not pathognomonic of hypothermia and also occurs in many other conditions, such as hypercalcemia [22], certain central nervous system lesions (subarachnoidal hemorrhage or cerebral injuries), Brugada syndrome, as well as in healthy persons with early repolarization [6][7][8]. Multiple medications, including class Ia and Ic anti-arrhythmic agents, cocaine, psychotropic medications, lithium, and antihistamines, can also simulate or provoke Brugada-or early repolarization-ECG patterns [1].…”

Section: Discussionmentioning

confidence: 99%

“…J-waves originate from the heterogeneous distribution of a transient outward current-mediated spike-and-dome morphology of the action potential across the ventricular wall. The presence of a prominent action potential notch in the epicardium, but not the endocardium, provides a voltage gradient that manifests as a J-wave or elevated J-point in the electrocardiogram [7,8]. Under hypothermic conditions, the epicardial potassium current is increased relative to the current in the endocardium during ventricular repolarization [8], producing a transmural voltage gradient that is reflected on the surface electrocardiogram as prominent J-waves.…”

Section: Discussionmentioning

confidence: 99%

“…Mounting evidence, however, suggests that careful attention should be paid to subjects who are at "high risk" [7,8], such as those presenting with prominent and distinct J-waves, transient augmentation of J-waves or J-point elevation >0.2 mV in the inferior or inferolateral ECG leads, association of an early repolarization pattern with a horizontal or descending ST-segment or short QT-intervals, and the appearance of very short-coupled extrasystoles. In our case, as well as in previous cases, the clinical course following the cessation of psychotropic drugs was uneventful.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Psychotropic drug-associated electrocardiographic presentation of diffuse J-waves in hypothermia: case report and literature review

2015

View full text Add to dashboard Cite

The use of psychotropic drugs is often associated with electrocardiographic (ECG) QT-interval prolongation, but there are few reports of J-waves. This report describes the case of a schizophrenic patient under treatment with several psychotropic drugs (olanzapine, valproate, and flunitrazepam), in whom ECG J-waves diffusely appeared during a hypothermic episode. We further performed a literature review of psychotropic drug-related J-waves in hypothermia. The present case highlights the importance of recognizing psychotropic drug-related ECG J-waves on an early warning sign to ensure appropriate monitoring and/or treatment for possible life-threatening side effects of such medications.

show abstract

Idiopathic Ventricular Fibrillation, Early Repolarization and Other J Wave-Related Ventricular Fibrillation Syndromes

Cited by 29 publications

References 68 publications

Brugada Syndrome Behind Complete Right Bundle-Branch Block

Brugada Syndrome Behind Complete Right Bundle-Branch Block

J Waves in Accidental Hypothermia

Psychotropic drug-associated electrocardiographic presentation of diffuse J-waves in hypothermia: case report and literature review

Contact Info

Product

Resources

About