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The prognostic value of early repolarization (J wave) and ST-segment morphology after J wave in Brugada syndrome:

Masahiko Takagi1, Kazutaka Aonuma, Yukio Sekiguchi

  • 1Department of Internal Medicine and Cardiology, Graduate School of Medicine, Osaka City University, Osaka, Japan. m7424580@msic.med.osaka-cu.ac.jp

Heart Rhythm
|January 1, 2013
PubMed

Insights

In Brugada syndrome (BS), inferolateral J waves and horizontal ST-segment morphology predict cardiac events. This finding helps identify patients with a higher risk of sudden cardiac death.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Diagnostics

Background:

  • The prognostic significance of J waves and subsequent ST-segment morphology in inferolateral leads for Brugada syndrome (BS) remains unclear.
  • Identifying reliable markers for risk stratification in BS is crucial for patient management.

Purpose of the Study:

  • To investigate the prognostic value of J wave characteristics and ST-segment morphology in a large Japanese cohort of Brugada syndrome patients.
  • To determine if specific ECG findings predict adverse cardiac events in BS.

Main Methods:

  • 460 consecutive Brugada syndrome patients were analyzed, categorized by clinical presentation (ventricular fibrillation, syncope, asymptomatic).
  • ECG parameters, including J wave presence, location, and ST-segment morphology, were assessed.
  • Clinical outcomes, specifically cardiac events (sudden cardiac death or ventricular fibrillation), were tracked during follow-up.

Main Results:

  • A J wave in inferior and/or lateral leads was present in 12% of patients, with similar prevalence across symptom groups.
  • Cardiac event incidence did not differ between patients with or without a J wave overall.
  • However, J waves in both inferior and lateral leads, or horizontal ST-segment morphology, were associated with a higher cardiac event incidence (P=.04 and P=.02).
  • Multivariate analysis identified symptoms, QRS duration >90 ms in V2, and inferolateral J wave/horizontal ST-segment morphology as predictors of cardiac events.

Conclusions:

  • The presence of J waves in multiple leads and horizontal ST-segment morphology may signify a highly arrhythmogenic substrate in Brugada syndrome.
  • These ECG findings can aid in identifying BS patients at increased risk for adverse cardiac events.
Abstract

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