Analysis of J waves during myocardial ischaemia.
OBJECTIVE
The aim of this study was to investigate the relationship between J-wave dynamics and arrhythmias during myocardial ischaemia in patients with vasospastic angina (VSA).


RESULTS
Sixty-seven consecutive patients diagnosed with VSA by a provocation test for coronary spasm were grouped according to whether they had a J wave in the baseline electrocardiograms or not (VSA-JW group, n = 14; VSA-non-JW group: n = 53). We retrospectively studied the associations between J-wave and ST-segment dynamics and induced ventricular fibrillations (VFs) during coronary spasm.  In the VSA-JW group, 7 of the 14 patients showed changes in J-wave morphology and/or gains in J-wave voltage, followed by VF in 4 patients. Compared with patients without VF, the four patients with VF showed similar maximal voltage in the baseline J waves but a higher voltage during induced coronary spasms (0.57 ± 0.49 vs. 0.30 ± 0.11 mV; P = 0.011). In three patients with VF, J waves progressively increased and were accompanied by the characteristic coved-type or lambda-shaped ST-segment elevations. In the VSA-non-JW group, only four patients showed new appearances of J waves during coronary spasms and another patient without a distinct J wave developed VF. Ventricular fibrillations were induced more frequently in the VSA-JW group than in the VSA-non-JW group [4/14 (29%) vs. 1/53 (2%); P = 0.012].


CONCLUSIONS
J-wave augmentations were caused by myocardial ischaemia during coronary spasms. The presence and augmentation of J waves, especially prominent J waves with the characteristic ST-elevation patterns, were associated with VF.
Division of Cardiology, Niigata University Graduate School of Medical and Dental Sciences, 1-754 Asahimachi-dori, Chuo-Ku, Niigata-City, Niigata 951-8510, Japan. akinosatou-circ@umin.ac.jp
Akinori
A
Sato
Yasuhiko
Y
Tanabe
Masaomi
M
Chinushi
Yuka
Y
Hayashi
Tsuyoshi
T
Yoshida
Eiichi
E
Ito
Daisuke
D
Izumi
Kenichi
K
Iijima
Nobue
N
Yagihara
Hiroshi
H
Watanabe
Hiroshi
H
Furushima
Yoshifusa
Y
Aizawa
D000109:Acetylcholine; D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000503:physiopathology*; D003329:Coronary Vasospasm / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology*; D012189:Retrospective Studies; D014665:Vasodilator Agents; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000503:physiopathology*
D014665:Vasodilator Agents; D000109:Acetylcholine