J wave dynamicity during coronary angiography and intracoronary acetylcholine administration

Abstract

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.

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

“…Recent studies have shown that J waves were augmented in amplitude or newly induced during CAG or intracoronary drug administration as summarized in Table 2. J waves were augmented in 109 patients during CAG 8–10,12,28,29 and in 50 patients during both CAG and intracoronary drug administration 10–12 …”

“…This J wave amplitude time course was similar to the changes in the QRS width and axis observed in patients who underwent CAG. 23 Furthermore, intracoronary administration of Ach was shown to augment J waves without inducing coronary spasm, [10][11][12] and J wave augmentation was also observed by intracoronary injection of nitroglycerin or ergotamine. We postulated that contrast media and NS may share a common mechanism for J wave augmentation.…”

“…Recent studies have shown that J waves were augmented in amplitude or newly induced during CAG or intracoronary drug administration as summarized in Table 2. J waves were augmented in 109 patients during CAG [8][9][10]12,28,29 and in 50 patients during both CAG and intracoronary drug administration. [10][11][12] J wave augmentation peaked within 10 sec and returned to baseline within another 10 sec or less after the beginning of the CAG.…”

“…J waves were augmented in 109 patients during CAG [8][9][10]12,28,29 and in 50 patients during both CAG and intracoronary drug administration. [10][11][12] J wave augmentation peaked within 10 sec and returned to baseline within another 10 sec or less after the beginning of the CAG. This J wave amplitude time course was similar to the changes in the QRS width and axis observed in patients who underwent CAG.…”

“…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.…”