Unmasking of J waves during Right Coronary Angiography in Patients with Spontaneous Coronary Spasms and Ventricular Fibrillation

Abstract

We encountered two consecutive cases with spontaneous ST elevation due to right coronary spasms and subsequent ventricular fibrillation (VF). Their 12-lead ECGs on anterior chest pain showed elevation of STsegments in the inferior leads, but coronary angiography (CAG) revealed no significant stenosis. Both cases showed dramatically evolving J waves in the inferior leads during the right CAG, but it was not observed during angiography of the left CAG. Neither Brugada-type ECG nor long-QT was evident. In summary, J waves can be produced without ST-segment elevation, and contrast media-induced J waves might be related to the arrhythmogenesis of subsequent VF evoked by right coronary spasms.

Inferior J waves in patients with vasospastic angina might be a risk factor for ventricular fibrillation

“…In the present study, J waves were simply defined by the morphological definition and we might have also overestimated the true incidence of J waves by counting an intraventricular conduction delay as ''J-point elevation'' [29]. It was not possible to evaluate the dynamic changes in the J waves during the cardiac catheterization and provocation test, and we might have overlooked any latent J waves caused by spasms [30]. We did not assess the aspect of depolarization abnormalities using signal averaged ECGs and ''tachycardia-dependent augmentation of notched J waves'' [31], and therefore we could not completely exclude the association of depolarization abnormalities and the possibility that some patients may have had a previous MI especially in patients with VTAs.…”

J wave dynamicity during coronary angiography and intracoronary acetylcholine administration

“…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.…”

“…4,5 The pathogenesis of J waves is, however, not always confirmed in each patient with various clinical situations. 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.…”