Evolving J waves prior to ventricular fibrillation postoperative coronary bypass

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Medical Diagnostics

Background:

• Coronary artery bypass grafting (CABG) is a common procedure for severe coronary artery disease.
• Postoperative cardiac arrhythmias, including ventricular fibrillation (VF), pose significant risks.
• Identifying predictive markers for VF is crucial for patient management.

Observation:

• A 74-year-old male developed ventricular fibrillation (VF) on the 4th postoperative day after CABG.
• Electrocardiogram (ECG) monitoring revealed evolving J waves preceding VF, without ST-segment elevation or QT prolongation.
• J waves diminished post-defibrillation and reappeared upon coronary angiography with contrast injection.

Findings:

• Evolving J waves in inferior leads were observed in a patient experiencing postoperative VF.
• The absence of typical ischemic ECG changes (ST elevation, QT prolongation) highlights the unique nature of these J waves.
• Reappearance of J waves with coronary angiography suggests a link to coronary artery patency and potential latent ischemia.

Implications:

• Evolving J waves may serve as a novel, early marker for latent myocardial ischemia.
• These J waves could be a valuable predictor of ventricular fibrillation in the postoperative cardiac surgery setting.
• Further research into J wave characteristics may improve risk stratification and management of post-CABG patients.