The relationship between J wave and ventricular tachycardia during Takotsubo cardiomyopathy
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International Journal of Arrhythmia Open Access
REVIEW
The relationship between J wave and ventricular tachycardia during Takotsubo cardiomyopathy Seong Huan Choi†, Oh‑Hyun Lee†, Gwang‑Seok Yoon, Sung Woo Kwon, Sung‑Hee Shin, Sang‑Don Park, Seong‑Ill Woo, Jun Kwan, Dae‑Hyeok Kim*† and Yong‑Soo Baek*†
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 fibril‑ lation 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 inter‑ val (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. Keywords: J wave, Ventricular tachycardia, Takotsubo cardiomyopathy Introduction Takotsubo cardiomyopathy (TTC) or apical ballooning syndrome is a form of reversible cardiomyopathy mimicking the symptomatology and electrocardiographic findings of acute myocardial infarction (AMI) without significant coronary artery disease on angiography [1]. Furthermore, life-threatening ventricular tachyarrhythmias *Correspondence: [email protected]; [email protected] † Seong Huan Choi and Oh-Hyun Lee have contributed equally to this work and are joint first authors. † Dae-Hyeok Kim and Yong-Soo Baek have contributed equally to this work. Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine and Inha University Hospital, 27 Inhang‑ro, Jung‑gu, Incheon 22332, Republic of Korea
caused by repolarization abnormalities and QTc prolongation, including torsades de pointes (TdP), may be seen in up to 8% of TTC patients [2]. The J point and ST-segment elevation which sometimes manifests as a notch or slur of the QRS (J wave) is the characteristic ECG pattern of early repolarization (ER). Moreover, recent studies have demonstrated that J wave on the sECG is associated with ventricular tachycardia (VT) and fibrillation (VF) in an experimental model consisting of canine ventricular wedge preparations [3]. This concept has now expanded to include other structural heart diseases such as AMI, variant angina, and e
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