Relationship Between an Ischaemic J Wave Pattern and Ventricular Fibrillation in ST-Elevation Myocardial Infarction Patients

Zhang, Luyao; Dong, Shujuan; Zhao, Wenbo; Li, Jingchao; Cui, Luqian; Han, Yongmei; Chu, Yongchao

doi:10.2147/ijgm.s337638

Cited by 2 publications

(2 citation statements)

References 35 publications

(58 reference statements)

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“…We retrospectively analyzed 272 cases of patients who fulfilled the inclusion criteria of this research and divided them into the survival group and the non-survival group first based on the primary endpoint. The 1-year mortality rate of AMI combined with new-onset RBBB was 21.32%, which was consistent with previous studies ( 7 , 22 ). In this study, the patients in the non-survival group had a higher level of CK-MB peak and lower EF% and a higher ratio of Killip class of ≥II than those in the survival group, which denoted a serious damage of the myocardium and cardiac function in the non-survival group.…”

Section: Discussionsupporting

confidence: 92%

The ratio of QRS/RV6-V1: a new electrocardiographic predictor of short- and long-term adverse clinical outcomes in patients with acute myocardial infarction combined with new-onset right bundle branch block

Cui

et al. 2023

Front. Cardiovasc. Med.

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BackgroundA few studies have focused on electrocardiography (ECG) parameters correlating with clinical prognosis in patients with acute myocardial infarction (AMI) combined with new-onset right bundle branch block (RBBB).ObjectiveTo assess the prognostic value of a new ECG parameter, namely, the ratio of QRS duration/RV6-V1 interval (QRS/RV6-V1), in patients with AMI combined with new-onset RBBB.Materials and methodsA total of 272 AMI patients combined with new-onset RBBB who received primary percutaneous coronary intervention (P-PCI) were retrospectively enrolled in the study. First, the patients were divided into survival group and non-survival group. Demographic, angiographic, and ECG characteristics were compared between the two groups. Receiver operating characteristic (ROC) curve was used to screen the best ECG parameter for predicting 1-year mortality. Second, the ratio of QRS/RV6-V1, a continuous variable, was converted to the high ratio group and low ratio group according to the optimal cutoff value point determined by the X-tile software. We compared the patient’s demographic, angiographic, and ECG characteristics, in-hospital major adverse cardiovascular events (MACE), and 1-year mortality between the two groups. Multivariate logistic and Cox regressions were used to evaluate whether the ratio of QRS/RV6-V1 was an independent prognostic factor of in-hospital MACE and 1-year mortality.ResultsThe ROC curve showed that the ratio of QRS/RV6-V1 had a higher value for predicting in-hospital MACE and 1-year mortality than the QRS duration, RV6-V1 interval, and RV1 interval. The patients in the high ratio group had significantly higher CK-MB peak and Killip class, lower ejection fraction (EF%), higher ratio of the left anterior (LAD) descending artery as infarct-related artery (IRA), and longer total ischemia time (TIT) than those in the low ratio group. The QRS duration was wider in the high ratio group than that in the low ratio group, whereas RV6-V1 was narrower in the high ratio group compared with that in the low ratio group. The in-hospital MACE rate (93.3% vs. 31.0%, p < 0.001) and 1-year mortality rate (86.7% vs. 13.2%, p < 0.001) in the high ratio group were higher than those in the low ratio group. The higher ratio of QRS/RV6-V1 was an independent predictor of in-hospital MACE (odds ratio, 8.55; 95% CI, 1.40–52.37; p = 0.02) after adjusting other confounders. Cox regression showed that the higher ratio of QRS/RV6-V1 predicted higher 1-year mortality of the patients with AMI combined with new-onset RBBB [hazard ratios (HR), 12.4; 95% CI, 7.26–21.22); p < 0.001] than the lower ratio of QRS/RV6-V1, and the HR still stayed at 2.21 even after a multivariable adjustment (HR, 2.21; 95% CI, 1.05–4.64); p = 0.037).ConclusionAccording to the results of our study, the high ratio of QRS/RV6-V1 (>3.0) was a valuable predictor of short- and long-term adverse clinical outcomes in AMI patients combined with new-onset RBBB. The implications of the high ratio of QRS/RV6-V1 were severe ischemia and pseudo synchronization between bi-ventricle.

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Section: Discussionsupporting

confidence: 92%

The ratio of QRS/RV6-V1: a new electrocardiographic predictor of short- and long-term adverse clinical outcomes in patients with acute myocardial infarction combined with new-onset right bundle branch block

Cui

et al. 2023

Front. Cardiovasc. Med.

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“…1). However, this ECG finding is recognized recently as a proarrhythmic sign responsible for the onset of idiopathic ventricular fibrillation (VF) and as a prognostic marker of variant angina and myocardial infarction, indicating a high risk of sudden arrhythmic death (15)(16)(17). J waves are influenced by autonomic nervous activity affecting various cardiac ion channels, and this unique wave shows dynamicity with day-today variation.…”

Section: Prominent J Wave Development In Asymptomatic Myocarditismentioning

confidence: 99%

Lessons Learnt from Case Series of Out-of-hospital Cardiac Arrest and Unexpected Death after COVID-19 Vaccination

Maruyama,

Uesako

2023

Intern. Med.

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Vaccination against COVID-19 has raised concerns about myocarditis in young men, as out-of-hospital cardiac arrest (OHCA) or sudden death after vaccination has been reported sporadically. Common features of these cases are occurrence in young men, within a few weeks after vaccination, in patients with no structural heart diseases. Cases of unexplained nocturnal death showed fibrotic or hypertrophied myocardium, and one case of OHCA presented ventricular fibrillation (VF) triggered by a prominent J wave on an automated external defibrillator and histopathologic findings compatible with myocarditis. Both myocarditis and J waves are prevalent in young men, and these cases imply that myocarditis augments J waves, which trigger VFs, and primary electrical disorders are a leading cause of death. To prevent such issues, artificial intelligence (AI)-assisted interpretation of historical electrocardiogram findings may help predict future J wave formation leading to VF, as digital electrocardiogram (ECG) findings are well suited for AI interpretation.

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Relationship Between an Ischaemic J Wave Pattern and Ventricular Fibrillation in ST-Elevation Myocardial Infarction Patients

Cited by 2 publications

References 35 publications

The ratio of QRS/RV6-V1: a new electrocardiographic predictor of short- and long-term adverse clinical outcomes in patients with acute myocardial infarction combined with new-onset right bundle branch block

The ratio of QRS/RV6-V1: a new electrocardiographic predictor of short- and long-term adverse clinical outcomes in patients with acute myocardial infarction combined with new-onset right bundle branch block

Lessons Learnt from Case Series of Out-of-hospital Cardiac Arrest and Unexpected Death after COVID-19 Vaccination

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