Analysis of J waves during myocardial ischaemia

• Published in: Europace (London, England) Vol. 14; no. 5; pp. 715 - 723
• Main Authors: Sato, Akinori, Tanabe, Yasuhiko, Chinushi, Masaomi, Hayashi, Yuka, Yoshida, Tsuyoshi, Ito, Eiichi, Izumi, Daisuke, Iijima, Kenichi, Yagihara, Nobue, Watanabe, Hiroshi, Furushima, Hiroshi, Aizawa, Yoshifusa
• Format: Journal Article
• Language: English
• Published: England 01.05.2012
• Subjects: Acetylcholine; Adult; Aged; Angina Pectoris - diagnosis; Angina Pectoris - physiopathology; Coronary Vasospasm - chemically induced; Coronary Vasospasm - diagnosis; Coronary Vasospasm - physiopathology; Electrocardiography - methods; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myocardial Ischemia - diagnosis; Myocardial Ischemia - physiopathology; Retrospective Studies; Vasodilator Agents; Ventricular Fibrillation - diagnosis; Ventricular Fibrillation - physiopathology
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/eur323

The aim of this study was to investigate the relationship between J-wave dynamics and arrhythmias during myocardial ischaemia in patients with vasospastic angina (VSA). Sixty-seven consecutive patients diagnosed with VSA by a provocation test for coronary spasm were grouped according to whether they had a J wave in the baseline electrocardiograms or not (VSA-JW group, n = 14; VSA-non-JW group: n = 53). We retrospectively studied the associations between J-wave and ST-segment dynamics and induced ventricular fibrillations (VFs) during coronary spasm.  In the VSA-JW group, 7 of the 14 patients showed changes in J-wave morphology and/or gains in J-wave voltage, followed by VF in 4 patients. Compared with patients without VF, the four patients with VF showed similar maximal voltage in the baseline J waves but a higher voltage during induced coronary spasms (0.57 ± 0.49 vs. 0.30 ± 0.11 mV; P = 0.011). In three patients with VF, J waves progressively increased and were accompanied by the characteristic coved-type or lambda-shaped ST-segment elevations. In the VSA-non-JW group, only four patients showed new appearances of J waves during coronary spasms and another patient without a distinct J wave developed VF. Ventricular fibrillations were induced more frequently in the VSA-JW group than in the VSA-non-JW group [4/14 (29%) vs. 1/53 (2%); P = 0.012]. J-wave augmentations were caused by myocardial ischaemia during coronary spasms. The presence and augmentation of J waves, especially prominent J waves with the characteristic ST-elevation patterns, were associated with VF.