Global and inferior J wave amplitudes associated with recurrent ventricular fibrillation


At Cardiostim, according to a study by Laurent Roten (Hôpital Cardiologique du Haut-Lévêque, Bordeaux, France) and others, in patients with early repolarisation and who had survived a sudden cardiac arrest, global and inferior J wave amplitudes were significantly higher in patients with recurrent ventricular fibrillation than in the remaining patients.

Roten explained that, although rare, there is a risk that some patients with inferolateral early repolarisation (ER) will have a sudden cardiac arrest. He said: “To date, we have no specific strategy for risk stratification in these patients. We know that the distribution of J waves might give some hint as to which patients are at increased risk.” He added that the aim of their study, therefore, was to correlate ECG characteristics with recurrent ventricular fibrillation in patients with inferolateral ER.

Patients in the study had inferolateral ER, had survived a sudden cardiac arrest, had a 12-lead ECG available for analysis, and had available follow-up data for recurrent, appropriate implantable cardioverter defibrillator interventions. Roten said: “With these ECGs, we analysed J waves (location, amplitude, morphology), ST segment of leads with J waves, and T peak to T end and T end/QT ration in lead V5.” Mean inferior, high lateral, and lateral J wave amplitudes and ST point scores were calculated for risk stratification.

After a median of follow-up of 42 months, 33 patients (45%) experienced recurrent ventricular fibrillation. Roten et al reported: “Patients with recurrent ventricular fibrillation had higher mean global J wave amplitudes (median 0.17mV vs. 0.13mV; p=0.002), inferior J wave amplitudes (0.17mV vs. 0.13mV; p=0.004), high lateral J wave amplitudes (0.14mV vs. 0.12mV; p=0.064), and lateral J wave amplitudes (0.18mV vs. 0.14mV; p=0.24) than patients without ventricular fibrillation recurrences.” They also found that malignant, descending/flat ST segment was the prevalent ST pattern among symptomatic ER patients and ascending (“benign”) ST segment pattern was rare; however, they did not find an association between ST segment pattern and recurrent ventricular fibrillation.

Roten concluded that in patients with inferolateral ER and sudden cardiac arrest, “Patients with recurrent ventricular fibrillation have significantly higher inferior/global J wave amplitudes than the remaining patients. Differences in ST segment morphology T end and T end/QT ratio were not associated with recurrent ventricular fibrillation.”