title: The prognostic value of early repolarization (J wave) and ST-segment morphology after J wave in Brugada syndrome: multicenter study in Japan.
abstract: BACKGROUND
  The prognostic value of a J wave and ST-segment morphology after J wave in inferolateral leads in Brugada syndrome (BS) is still unknown.
  
  
  OBJECTIVE
  To evaluate the prognostic value of a J wave and ST-segment morphology after J wave in a large Japanese cohort of BS.
  
  
  METHODS
  A total of 460 consecutive patients with BS (mean age 52±14 years, 432 men) were enrolled. The presence and location of leads showing a J wave, ST-segment morphology after J wave, and clinical outcomes were evaluated in patients with documented ventricular fibrillation (VF) (N = 84), those with syncope without documented VF (N = 109), and subjects without symptoms (N = 267).
  
  
  RESULTS
  The prevalence of a J wave in the inferior and/or lateral leads was 12% (53 cases). The prevalence of a J wave among the 3 groups was not different. The incidence of cardiac events (sudden cardiac death or VF) during a mean follow-up period of 50±32 months was not different in patients with (11%) or without (8%) a J wave. Patients with a J wave in both inferior and lateral leads or with horizontal ST-segment morphology after J wave showed a higher incidence of cardiac events than those without (P = .04 and .02, respectively). Multivariate analysis revealed symptoms, QRS duration in lead V2>90 ms, and inferolateral J wave and/or horizontal ST-segment morphology after J wave were important for predicting cardiac events.
  
  
  CONCLUSIONS
  The presence of a J wave in multiple leads and horizontal ST-segment morphology after J wave may indicate a highly arrhythmogenic substrate in patients with BS.
authors.affiliation: Department of Internal Medicine and Cardiology, Graduate School of Medicine, Osaka City University, Osaka, Japan. m7424580@msic.med.osaka-cu.ac.jp
authors.forename: Masahiko
authors.initials: M
authors.lastname: Takagi
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sekiguchi
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Naohiko
authors.initials: N
authors.lastname: Aihara
authors.forename: Masayasu
authors.initials: M
authors.lastname: Hiraoka
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D053840:Brugada Syndrome / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D002423:Cause of Death; D003430:Cross-Sectional Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D013575:Syncope / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000628:therapy