Risk Stratification of the J Wave Syndrome
Appearance of a J wave is a potent risk for idiopathic ventricular fibrillation (VF). The incidence of inferolateral J wave is higher in patients with idiopathic VF than that in control subjects. Patients having a higher and widespread J wave with horizon
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Risk Stratification of the J Wave Syndrome Atsuyuki Watanabe and Hiroshi Morita
Abstract Appearance of a J wave is a potent risk for idiopathic ventricular fibrillation (VF). The incidence of inferolateral J wave is higher in patients with idiopathic VF than that in control subjects. Patients having a higher and widespread J wave with horizontal/descending ST segments are at high risk for arrhythmic events (malignant early repolarization (ER)), and it is associated with arrhythmic storm. J wave dynamicity, fragmented QRS, and T wave abnormality will be even more high-risk signs in patients with malignant ER. Occurrence of short coupled premature ventricular contractions can be a precursor of VF and sudden death. Patients who have experienced aborted cardiac arrest or ventricular tachyarrhythmias should receive an implantable cardioverter defibrillator. Cohort studies have shown that inferolateral J wave is also a risk marker for the cardiovascular and arrhythmic events. High and widespread J wave is also a risk for the arrhythmic events in general population, but the occurrence of idiopathic VF is very rare. The incidence of the idiopathic VF will be 90:100,000 in persons with a tall J wave with a horizontal/descending ST segment. The existence of J wave will increase the risk of VF during acute ischemia or in patients with structural heart diseases. In patients with inherited arrhythmic syndrome, J wave also increases the risk of VF.
6.1 Introduction Early repolarization (ER), a concave ST elevation in the left precordial leads, is a common finding in young people, particularly males and athletes, and it had been believed to be an innocent sign of the ECG. The J wave can appear along with the ST elevation of ER. A prominent J wave was also reported in a hypothermic condition [1] and is known as Osborn wave. ST elevation in the right precordial leads was A. Watanabe, M.D., Ph.D. Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan H. Morita, M.D., Ph.D. (*) Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan e-mail: [email protected] © Springer Nature Singapore Pte Ltd. 2018 W. Shimizu (ed.), Early Repolarization Syndrome, DOI 10.1007/978-981-10-3379-7_6
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reported in the 1950s and was thought to be ER in the right ventricle. Both ER patterns in the right and left precordial leads had not been recognized for a long time as a significant prognostic sign. However, in 1992, Brugada et al. reported idiopathic ventricular fibrillation (VF) with ST elevation in the right precordial leads [2], which has attracted cardiologist’s attention as Brugada syndrome. In the case of a J wave, Aizawa et al. reported a patient of idiopathic VF with a prominent J wave in 1992 [3], and Gussak and Antzelevitch reported the possibility of arrhythmogenesis of the J wave in 2000 [4]. However, there was no clinical recogn
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