Sudden Cardiac Arrest Associated with Early Repolarization

Haı̈ssaguerre, Michel; Derval, Nicolas; Sacher, Frédéric; Jesel, Laurence; Deisenhofer, Isabel; Roy, Luc De; Pasquié, Jean‐Luc; Nogami, Akihiko; Babuty, Dominique; Yli‐Mäyry, Sinikka; Chillou, Christian de; Scanu, P; Mabo, Philippe; Matsuo, Seiichiro; Probst, Vincent; Scouarnec, Solena Le; Defaye, Pascal; Schlaepfer, J.; Rostock, Thomas; Lacroix, Dominique; Lamaison, D; Lavergne, Thomas; Aizawa, Yoshifusa; Englund, Anders; Anselme, F.; O’Neill, Mark; Hocini, Mélèze; Lim, Kang Teng; Knecht, Sébastien; Veenhuyzen, George D.; Bordachar, Pierre; Chauvin, Michel; Jaı̈s, Pierre; Coureau, Gaëlle; Chêne, Geneviève; Klein, George J.; Clémenty, Jacques

doi:10.1056/nejmoa071968

Cited by 1,290 publications

(1,231 citation statements)

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“…However, in addition to J‐wave augmentation, QRS interval widening and J‐ST–segment elevation were also documented in previously reported cases of ERS, in accordance with electrocardiographic characteristics observed in acute ischemia settings 9, 10, 19. In this study, available ECGs before the onset of VF in 3 patients with CAS also showed specific J‐wave and QRST characteristics, in agreement with previous ERS studies 1, 12. Inamura et al showed that the J wave was augmented in the leads associated with ischemic areas, caused by acetylcholine‐induced vasospasm 10.…”

Section: Discussionsupporting

confidence: 92%

“…J‐wave augmentation before the onset of VF is considered a typical electrocardiographic feature in patients with ERS 1, 12. However, in addition to J‐wave augmentation, QRS interval widening and J‐ST–segment elevation were also documented in previously reported cases of ERS, in accordance with electrocardiographic characteristics observed in acute ischemia settings 9, 10, 19.…”

Section: Discussionsupporting

confidence: 76%

“…In 2008, Haïssaguerre et al associated, for the first time, the J‐wave elevation in the inferolateral leads with idiopathic VF 1. Since then, studies have shown that the presence of a J wave is indicative of a high risk for fatal ventricular arrhythmias in patients with Brugada syndrome17 and acute myocardial infarction 18…”

Section: Discussionmentioning

confidence: 99%

“…The presence of inferolateral J wave, defined as an elevation of the J point in ≥2 contiguous leads, was evaluated at baseline using 12‐lead electrocardiography (25 mm/s and 10 mm/mV) 1, 14. The amplitude of the inferolateral J wave or J‐point elevation had to be ≥1 mm or 0.1 mV above the baseline level, either as QRS slurring or notching in any of the inferior (II, III, and aVF), lateral (V 4 , V 5 , and V 6 ), and high lateral (I and aVL) leads in at least 1 electrocardiographic recording.…”

Section: Methodsmentioning

confidence: 99%

“…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…”

mentioning

confidence: 99%

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

Kamakura

Wada

Ishibashi

et al. 2018

JAHA

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BackgroundPreviously described patients with early repolarization syndrome (ERS) may have experienced silent coronary artery spasm (CAS) because the diagnosis of CAS was mainly based on symptoms or coronary angiography findings, without performing a spasm provocation test. This study investigated the significance of CAS diagnosis and evaluated the incidence of silent CAS in patients with possible ERS (ie, idiopathic ventricular fibrillation [VF] and inferolateral J wave).Methods and ResultsThe study included 34 patients with idiopathic VF and inferolateral J wave. Thirteen patients (38%) were diagnosed as having CAS on the basis of coronary angiography with spasm provocation test (n=8) and documentation of spontaneous ST elevation (n=5). Of the 13 patients with CAS, 5 (38%) did not experience chest symptoms before and during VF, and were diagnosed as having silent CAS. The remaining 21 patients (62%), with a negative provocation test result and absence of chest symptoms, were considered to have ERS. During the 92 months of follow‐up, patients with CAS receiving appropriate medical treatment with antianginal drugs showed a favorable outcome. In contrast, 4 of 21 patients with ERS (19%) had VF recurrences. The use of monotherapy or combination therapy, consisting of quinidine, cilostazol, and bepridil, in the 4 patients with ERS, was effective in suppressing VF.ConclusionsApproximately 40% of patients with CAS with documented VF and inferolateral J wave did not experience chest symptoms at the first VF, and could have been misdiagnosed as having ERS. The use of the spasm provocation test is considered essential to differentiate patients for optimal medical treatment.

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