J point elevation in high precordial leads associated with risk of ventricular fibrillation
Yuki Hasegawa1, Hiroshi Watanabe1, Yasuhiro Ikami
1Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences.
Insights
High precordial electrocardiograms reveal J point elevation in the 3rd intercostal space is linked to idiopathic ventricular fibrillation (IVF) and recurrent events. This finding may aid in identifying sudden cardiac death risk.
Area of Science:
- Cardiology
- Electrophysiology
- Sudden Cardiac Death
Background:
- Idiopathic ventricular fibrillation (IVF) poses a risk for sudden cardiac death.
- The diagnostic utility of high precordial electrocardiograms (ECGs) in IVF remains unclear.
Purpose of the Study:
- To investigate the significance of J point elevation in high precordial ECGs for diagnosing IVF.
- To assess the association between J point elevation and ventricular fibrillation recurrence.
Main Methods:
- Compared ECGs from 35 IVF patients and 15 Brugada syndrome patients to 105 healthy controls.
- Focused on J point elevation (≥0.1 mV) in the 3rd and 4th intercostal spaces.
- Analyzed recurrence of ventricular fibrillation during follow-up.
Main Results:
- J point elevation in the 3rd intercostal space was significantly higher in IVF patients (40%) than controls (11%).
- Elevation in the 3rd but not 4th intercostal space occurred in 30% of IVF patients vs. 6% of controls.
- Higher recurrence of ventricular fibrillation was observed in IVF patients with 3rd intercostal space J point elevation (36%) and Brugada syndrome (40%).
Conclusions:
- J point elevation in the 3rd intercostal space is associated with idiopathic ventricular fibrillation.
- High precordial ECG findings may help identify individuals at risk for sudden cardiac death.
Introduction:
The significance of high precordial electrocardiograms in idiopathic ventricular fibrillation (IVF) is unknown.
Method:
This study included 50 consecutive patients (48 men; age, 42 ± 18 years) who had spontaneous ventricular fibrillation not linked to structural heart disease and received implantable cardiac defibrillator therapy. IVF was diagnosed in 35 patients and Brugada syndrome was diagnosed in other 15 patients. Electrocardiograms in high intercostal space were compared between 35 patients with IVF and 105 age- and sex-matched healthy controls (patient: control ratio, 1:3).
Results:
The frequency of J point elevation ≥ 0.1 mV in the 4th intercostal spaces was similar between patients with IVF (14%) and healthy controls (7%). However, the frequency of J point elevation ≥ 0.1 mV in the 3rd intercostal space was higher in patients with IVF (40%) than controls (11%) (p < .01). J point elevation was present only in the 3rd intercostal space but not in the 4th intercostal space in 30% of patients with IVF but only in 6% of controls (p < .01). During follow-up, the recurrence of ventricular fibrillation was higher in patients with IVF who had J point elevation in the 3rd intercostal space (36%) and Brugada syndrome(40%) than those with IVF who did not have J point elevation in the 3rd intercostal space(11%) (p < .05 for both).
Conclusion:
J point elevation in the 3rd intercostal space was associated with IVF and recurrences of ventricular fibrillation. Electrocardiogram recordings in the high intercostal space may be useful to identify risk of sudden death.
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