Accentuation of J waves by intracoronary administration of multiple agents in a patient with vasospastic angina: Implications for pathogenesis

Sakaguchi, Yuta; Fuse, Koichi; Kitazawa, Hitoshi; Ikeda, Yoshio; Sato, Takao; Okabe, Masaru; Aizawa, Yoshifusa

doi:10.1016/j.jelectrocard.2019.06.014

Cited by 6 publications

(10 citation statements)

References 7 publications

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“…Following a case report of a VSA patient in whom unmasking of J waves by CAG was shown, 7 subsequent studies showed augmentation or new occurrence of J waves during CAG or Ach administration in VSA patients 8–11 . However, it is unknown whether J waves were changed similarly during CAG and Ach administration in the same individuals, and the present study confirmed that J waves were augmented or newly developed similarly in the same individuals during CAG and Ach administration, and some mechanism(s) responsible for the new appearance or augmentation of J waves might be postulated.…”

Section: Discussionsupporting

confidence: 67%

“…Meanwhile, J waves have been observed to be induced or augmented during coronary angiography (CAG) 7–9 or during the intracoronary administration of acetylcholine (Ach) 10,11 . J wave changes have been observed in individuals who underwent CAG or Ach administration separately, and whether both CAG and Ach administration cause similar changes in J waves is unknown.…”

Section: Introductionmentioning

confidence: 99%

“…2,6 Meanwhile, J waves have been observed to be induced or augmented during coronary angiography (CAG) [7][8][9] or during the intracoronary administration of acetylcholine (Ach). 10,11 J wave changes have been observed in individuals who underwent CAG or Ach administration separately, and whether both CAG and Ach administration cause similar changes in J waves is unknown. Therefore, we investigated the dynamicity of J waves in individuals who underwent both CAG and Ach administration for the diagnosis of vasospastic angina (VSA) and compared between the two coronary interventions.…”

Section: Introductionmentioning

confidence: 99%

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J wave dynamicity during coronary angiography and intracoronary acetylcholine administration

Aizawa

Ohashi

Kawamura

et al. 2023

Pacing Clinical Electrophis

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BackgroundJ‐waves may be observed during coronary angiography (CAG) or intracoronary acetylcholine (ACh) administration, but their significance is unknown.MethodsForty‐nine patients, 59.1 ± 11.5 years old and 59% male, were studied on suspicion of vasospastic angina, and J wave dynamicity was compared between CAG and Ach administration.ResultsDiagnostic (≥0.1 mV) or nondiagnostic (<0.1 mV) J waves in 9 and 3 patients, respectively, were augmented, and J waves were newly observed in 2 patients during CAG and Ach administration. Similar changes in the J‐wave amplitude were observed: from 0.10 ± 0.09 mV to 0.20 ± 0.15 mV (p < .002) and from 0.10 ± 0.10 mV to 0.20 ± 0.16 mV (p < .001) during CAG and Ach administration, respectively. J waves were located in the inferior leads and changed only during the right coronary interventions. In the remaining 35 patients, J waves were absent before and during the coronary interventions. Augmentation of J waves was found when the RR interval was shortened in some patients. Injection of anoxic media into the coronary artery might induce a conduction delay from myocardial ischemia that manifests as augmentation or new occurrence of J waves.ConclusionsBoth CAG and intracoronary Ach administration affected J waves similarly in the same individuals. A myocardial ischemia‐induced conduction delay may be responsible for the changes in J waves, but further studies are needed.

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Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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J wave dynamicity during coronary angiography and intracoronary acetylcholine administration

Aizawa

Ohashi

Kawamura

et al. 2023

Pacing Clinical Electrophis

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“…In patients with VSA, angina attacks mainly occur between midnight and early morning, and the ER pattern could be associated with the development of VF. [7][8][9] In the present case, it was uncertain whether the cause of VF was ERS or VSA, and therefore, we prescribed 100 mg/day of bepridil, which is a calcium antagonist with fast kinetic block of sodium current that inhibits most type of potassium currents including Ito, with abstinence from smoking and drinking. However, VF recurred J o u r n a l P r e -p r o o f despite these measures and ERS rather than VSA was diagnosed with the main cause of VF.…”

Section: Discussionmentioning

confidence: 79%

Recurrent ventricular fibrillation in a patient with inferolateral early repolarization and higher testosterone level

Yamaguchi

Sakamoto

Hata

et al. 2022

HeartRhythm Case Reports

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“…Further, acetylcholine (Ach) given intracoronarily was shown to augment J wave at doses which failed to provoke coronary spasm. [10][11][12] Ach might act directly on J waves augmenting the amplitude, but this was felt unlikely since normal saline (NS) used as a vehicle can be the cause of J wave augmentation.…”

Section: Introductionmentioning

confidence: 99%

Is ischemic stimulus involved for J wave augmentation during coronary angiography and intracoronary administration of normal saline?

Nakayama,

Matsuo,

Sato

et al. 2024

Pacing Clinical Electrophis

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BackgroundJ waves may be augmented by coronary angiography (CAG) or intracoronary drug administration but the underlying mechanism is unknown.PurposeThe effect of intracoronary normal saline (NS) on J waves were investigated.Patients and methodsAfter the standard CAG using iopamidol (IopamiroR Inj), NS was injected into the right coronary artery in 10 patients with and eight patients without J waves at the baseline. The 12‐lead ECG was monitored, stored on a computer and retrieved later for measurement of the J wave amplitude before or during the coronary interventions.ResultsJ waves in leads II, III and aVF at baseline increased significantly in each lead during the right CAG and NS injection into the right coronary artery. The J wave changes were similar between the two interventions and distinct similar alterations were observed in the QRS complex.We postulated that the ischemic myocardium that was induced during CAG or intracoronary NS administration slowed the conduction velocity of depolarization in the perfusion territory and delayed the timing of J waves to appear. Then, the delayed appearance of J waves would be less opposed by electromotive force from other areas resulting in augmentation.ConclusionJ wave augmentation was observed during CAG and intracoronary NS administration. As a mechanism of augmentation, we postulated that contrast media and NS induce myocardial ischemia and delay the timing of J waves to a point of less opposition by electromotive force from other areas.Highlights J wave augmentation has been reported during intracoronary injection of contrast media or drugs. The present study confirmed that normal saline alone was able to augment J waves. Mechanistically, coronary interventions using anoxic solutions can cause regional myocardial ischemia and reduce the conduction velocity of depolarization. Then, delayed J waves are less opposed by the electromotive force from remote areas which leads to augmentation. When a drug is diluted in normal saline and given intracoronarily, changes in J waves can be due to normal saline. The pathophysiological and clinical significance of J waves augmented during coronary interventions need to be established.

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Accentuation of J waves by intracoronary administration of multiple agents in a patient with vasospastic angina: Implications for pathogenesis

Cited by 6 publications

References 7 publications

J wave dynamicity during coronary angiography and intracoronary acetylcholine administration

J wave dynamicity during coronary angiography and intracoronary acetylcholine administration

Recurrent ventricular fibrillation in a patient with inferolateral early repolarization and higher testosterone level

Is ischemic stimulus involved for J wave augmentation during coronary angiography and intracoronary administration of normal saline?

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