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Multicenter Study
. 2024 Jan;10(1):1-12.
doi: 10.1016/j.jacep.2023.09.013. Epub 2023 Oct 18.

Triggers of Ventricular Fibrillation in Patients With Inferolateral J-Wave Syndrome

Yuki Komatsu  1 , Akihiko Nogami  2 , Mélèze Hocini  3 , Hiroshi Morita  4 , Nobuyuki Sato  5 , Eloi Marijon  6 , Thomas Arentz  7 , Sinikka Yli-Mäyry  8 , Yoshimi Onishi  9 , Shinya Kowase  10 , Josselin Duchateau  3 , Karim Benali  3 , Tetsuro Takase  11 , Yukio Hosaka  12 , Asumi Takei  13 , Ikutaro Nakajima  14 , Mitsuharu Kawamura  9 , Yasuya Inden  15 , Masaki Ieda  2 , Kazutaka Aonuma  2 , Michel Haïssaguerre  3
Affiliations
Free article
Multicenter Study

Triggers of Ventricular Fibrillation in Patients With Inferolateral J-Wave Syndrome

Yuki Komatsu et al. JACC Clin Electrophysiol. 2024 Jan.
Free article

Abstract

Background: There are few data on ventricular fibrillation (VF) initiation in patients with inferolateral J waves.

Objectives: This multicenter study investigated the characteristics of triggers initiating spontaneous VF in inferolateral J-wave syndrome.

Methods: A total of 31 patients (age 37 ± 14 years, 24 male) with spontaneous VF episodes associated with inferolateral J waves were evaluated to determine the origin and characteristics of triggers. The J-wave pattern was recorded in inferior leads in 11 patients, lateral leads in 3, and inferolateral leads in 17.

Results: The VF triggers (n = 37) exhibited varying QRS durations (176 ± 21 milliseconds, range 119-219 milliseconds) and coupling intervals (339 ± 46 milliseconds, range 250-508 milliseconds) with a right (70%) or left (30%) bundle branch block (BBB) pattern. Trigger patterns were associated with J-wave location: left BBB triggers with inferior J waves and right BBB triggers with lateral J waves. Electrophysiologic study was performed for 22 VF triggers in 19 patients. They originated from the left or right Purkinje system in 6 and from the ventricular myocardium in 10 and were undetermined in 6. Purkinje vs myocardial triggers showed distinct electrocardiographic characteristics in coupling interval and QRS-complex duration and morphology. Abnormal epicardial substrate associated with fragmented electrograms was identified in 9 patients, with triggers originating from the same region in 7 patients. Catheter ablation resulted in VF suppression in 15 patients (79%).

Conclusions: VF initiation in inferolateral J-wave syndrome is associated with significant individual heterogeneity in trigger characteristics. Myocardial triggers have electrocardiographic features distinct from Purkinje triggers, and their origin often colocalizes with an abnormal epicardial substrate.

Keywords: catheter ablation; inferolateral J waves; sudden cardiac death; ventricular fibrillation.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Komatsu has received honoraria from Johnson and Johnson for lectures and advisory board activities. Dr Nogami has received honoraria from Abbott and Biosense Webster; and an endowment from Medtronic and DVx. Dr Hocini has received grants from Medtronic. Dr Morita is affiliated with a department endowed by Japan Medtronic. Dr Nakajima received honoraria from Medtronic. Dr Ieda has received grants from Fukuda Denshi, Japan Lifeline, Medtronic, DVx, Boston Scientific, Nihon Kohden, Toray, Biotronik Japan, ASTEC, Abbott, Nippon Boehringer lngelheim, and Otsuka Pharmaceutical. Dr Haïssaguerre has received an endowment from Biosense-Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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