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. 2021 Nov 23:14:8725-8735.
doi: 10.2147/IJGM.S337638. eCollection 2021.

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

Luyao Zhang #  1 , Shujuan Dong #  1 , Wenbo Zhao  1 , Jingchao Li  1 , Luqian Cui  1 , Yongmei Han  1 , Yingjie Chu  1
Affiliations

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

Luyao Zhang et al. Int J Gen Med. .

Abstract

Background: This study determined the ischaemic J wave pattern associated with ventricular fibrillation (VF).

Methods: A total of 262 patients diagnosed with ST-elevation myocardial infarction (STEMI) were recruited from October 2017 to September 2020. All data were collected and analysed, including baseline characteristics, electrocardiogram (ECG), coronary angiography (CAG), and examination outcomes.

Results: There were 193 STEMI patients with J wave elevation but without an ischaemic J wave (NJ group) and 69 patients with an ischaemic J wave; the latter were then subgrouped into early repolarization pattern (ERP; n=62) and Brugada pattern groups (BrP [anteroseptal ERP]; n=7). Univariate and multivariate logistic regression analyses were used to clarify high-risk factors and characteristics of ischaemic J waves. Multivariate logistic regression analysis revealed that an ischaemic J wave (odds ratio [OR], 9.708; 95% CI, 2.570-36.664; P=0.01) independently predicted VF. In the subgroup analysis, BrP (OR, 31.214; 95% CI, 3.949-246.742; P=0.001), slur morphology of the ERP (OR, 8.15; 95% CI, 1.563-42.558; P<0.05), and the number of leads with an ischaemic J wave > 3 (OR, 16.174; 95% CI, 3.064-85.375; P=0.001) were significantly associated with VF occurrence after adjusting for multiple variables.

Conclusion: An ischaemic J wave is an independent risk factor for VF in STEMI patients. BrP, slur morphology, and > 3 leads with an ischaemic J wave could increase the incidence of VF.

Keywords: STEMI; classification; ischaemic J wave; predictor; ventricular fibrillation.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
ECG of a 46-year-old man with chest pain for 1 hour at the time of admission. Leads II, III, and AVF show a slur-type ischaemic J wave (indicated by red arrows). CAG showed the culprit artery to be the LAD, which was consistent with the leads showing an ischaemic J wave. Twenty-seven minutes later, an ischaemic J wave in leads II and III and AVF disappeared, indicating that the J wave occurred in the very early phase and changed with the development of ischaemia.
Figure 2
Figure 2
The ECG of a 55-year-old man presenting with chest pain for approximately 1 h. A notch J wave (indicated by red arrows) is present in leads II, III, AVF, and V6 with ST segment elevation consistent with the scope of blood supply to the RCA.
Figure 3
Figure 3
A BrP in leads V1-V4 and sudden cardiac death occurred in this patient. A BrP with ischaemic J wave is indicated by the red arrows.
Figure 4
Figure 4
The records for the patient are shown in Figure 3. When he returned to the CCU after the procedure, ventricular arrhythmia was noted, and he was shocked immediately. He declined an ICD implant and requested discharge 7 days later.
See this image and copyright information in PMC

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