J wave syndromes

Abstract

The J wave, also referred to as an Osborn wave, is a deflection immediately following the QRS complex of the surface ECG. When partially buried in the R wave, the J wave appears as a J point elevation or ST segment elevation. Several lines of evidence have been advanced suggesting that arrhythmias associated with early repolarization (ER) pattern in the inferior leads or mid- to lateral precordial leads, Brugada syndrome (BrS) as well arrhythmias associated with hypothermia and the acute phase of ST segment elevation myocardial infarction (STEMI), are mechanistically linked to abnormalities in the manifestation of the transient outward current (Ito)-mediated J wave. Although BrS and early repolarization syndrome (ERS) differ with respect to the magnitude and lead location of abnormal J wave manifestation, they can be considered to represent a continuous spectrum of phenotypic expression that we propose be termed J wave syndromes. This review attempts to summarize our current state of knowledge concerning J-wave syndromes, bridging basic and clinical aspects. We propose to divide ERS into three subtypes: Type 1, displaying an ER pattern predominantly in the lateral precordial leads, is prevalent among healthy male athletes and rarely seen in VF survivors; Type 2, displaying an ER pattern predominantly in the inferior or infero-lateral leads, is associated with a higher level of risk; whereas Type 3, displaying an ER pattern globally in the inferior, lateral and right precordial leads, is associated with the highest level of risk for development of malignant arrhythmias and is often associated with VF storms.

The Early Repolarization ECG Pattern – An Update

“…Their hypothesis was the following: for the appearance and shape of the J-wave the transient outward potassium current is responsible, which, being not uniformly active in the myocardium, produces differences between the epicardial and endocardial action potential (AP) shapes [3,8].…”

“…In acute setting, another therapeutic approach is to increase heart rate beyond 90, up to 120 beats/min with isoproterenol infusion, which can suppress ventricular arrhythmias. In patients who are not responsive to pharmacological treatment endocardial ablation of ectopic foci in the early repolarization zone can be useful [2,3].…”

“…Deviation of this point from the isoelectric line determine the presence of J-deflection (wave), which could be followed by upsloping or horizontal ST-segment elevation, determining the appearance of early repolarization ECG pattern (ERP). The ERP was first described in 1936 by Shipley and Hallaran, who studied 200 young healthy men and women and described the Jdeflection as notching of the descending part of the QRS complex [1][2][3].…”

“…Deviation of this point from the isoelectric line determine the presence of J-deflection (wave), which could be followed by upsloping or horizontal ST-segment elevation, determining the appearance of early repolarization ECG pattern (ERP). The ERP was first described in 1936 by Shipley and Hallaran, who studied 200 young healthy men and women and described the Jdeflection as notching of the descending part of the QRS complex [1][2][3].ERP was considered previously as a benign, "innocent", ECG phenomenon, as a distinct form of the so called J-wave syndromes (which include also the Brugada syndrome). However, in the last ten years, epidemiological and case-control studies found some forms of ERP to be predictors and risk factors for sudden cardiac death (primary ventricular fibrillation).…”

Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

“…Early repolarization syndrome (ERS) is defined as inferolateral J wave after resuscitation from idiopathic ventricular fibrillation (VF), in the absence of other causes of cardiac arrest, such as coronary artery disease 1, 2…”