Differences in the onset mode of ventricular tachyarrhythmia between patients with J wave in anterior leads and those with J wave in inferolateral leads

Tsukasa Kamakura; Mitsuru Wada; Kohei Ishibashi; Yuko Y Inoue; Koji Miyamoto; Hideo Okamura; Satoshi Nagase; Takashi Noda; Takeshi Aiba; Satoshi Yasuda; Wataru Shimizu; Shiro Kamakura; Kengo Kusano

doi:10.1016/j.hrthm.2016.11.027

Differences in the onset mode of ventricular tachyarrhythmia between patients with J wave in anterior leads and those with J wave in inferolateral leads

Heart Rhythm. 2017 Apr;14(4):553-561. doi: 10.1016/j.hrthm.2016.11.027. Epub 2016 Nov 23.

Affiliations

¹ Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: tkamakura@live.jp.
² Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
³ Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.

PMID: 27890733
DOI: 10.1016/j.hrthm.2016.11.027

Abstract

Background: The pathophysiological mechanism of J wave in anterior leads (A-leads) and inferolateral leads (L-leads) remains unclear.

Objective: We investigated the onset mode and circadian distribution of ventricular tachyarrhythmia (VTA) episodes between patients with early repolarization syndrome (ERS) and Brugada syndrome (BrS).

Methods: The study enrolled 35 patients with ERS and 52 patients with type 1 BrS with spontaneous ventricular fibrillation who were divided into 4 groups: ERS(A+L) (n = 15), patients with ERS who had a non-type 1 Brugada pattern electrocardiogram in any A-leads (second to fourth intercostal spaces) in control and/or after drug provocation tests; ERS(L) (n = 20), patients with ERS with J wave only in L-leads; BrS(A) (n = 24), patients with BrS without J wave in L-leads; and BrS(A+L) (n = 28), patients with BrS with J wave in L-leads. The onset mode of 206 VTAs obtained from electrocardiograms or implantable cardioverter-defibrillators and the circadian distribution of 352 VTAs were investigated in the 4 groups.

Results: Three groups with J wave in A-leads, ERS(A+L), BrS(A), and BrS(A+L), had higher incidences of nocturnal (63%, 43%, and 47%, respectively) and sudden onset VTAs (67%, 97%, and 86%, respectively) with longer coupling intervals of premature ventricular contractions (388.8, 397.3, and 385.6 ms, respectively) than the ERS(L) group with J wave only in L-leads (25%, P = .0019; 19%, P < .0001; and 330.6 ms, P = .0004, respectively), the last of which mainly displayed VTAs with a short-long-short sequence.

Conclusion: The onset mode of VTAs was different between patients with J wave in A-leads and patients with J wave in only L-leads. The underlying mechanism of J wave may differ between A-leads and L-leads.

Keywords: Brugada syndrome; Early repolarization syndrome; J wave; Ventricular fibrillation; Ventricular tachyarrhythmia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Brugada Syndrome* / diagnosis
Brugada Syndrome* / physiopathology
Brugada Syndrome* / surgery
Circadian Rhythm / physiology
Defibrillators, Implantable / adverse effects*
Electrophysiologic Techniques, Cardiac / methods
Female
Humans
Japan
Male
Middle Aged
Prosthesis Fitting / methods
Retrospective Studies
Statistics as Topic
Tachycardia, Ventricular* / diagnosis
Tachycardia, Ventricular* / physiopathology
Tachycardia, Ventricular* / prevention & control