title: Tachycardia-dependent augmentation of "notched J waves" in a general patient population without ventricular fibrillation or cardiac arrest: not a repolarization but a depolarization abnormality?
abstract: BACKGROUND
  J waves can be observed in individuals of the general population, but electrocardiographic characteristics are poorly understood.
  
  
  OBJECTIVE
  The purpose of this study was to examine the J-wave dynamicity in a general patient population.
  
  
  METHODS
  The responses of J waves (>0.1 mV above the isoelectric line in 2 contiguous leads) to varying RR intervals were analyzed. Patients with aborted sudden cardiac death, documented ventricular fibrillation, or a family history of sudden cardiac death were excluded. The J-wave amplitude was measured at baseline, in beats with short RR intervals in conducted atrial premature beats (APBs) or atrial stimulation during the electrophysiology study, and in the beats next to APBs with prolonged RR intervals.
  
  
  RESULTS
  Mainly notched J waves were identified in 94 of 701 (24.5%) general patients (13.4%), and APBs were present in 23 of 94 (24.5%) patients. The mean baseline amplitude of J waves was 0.20 ± 0.06 mV at the baseline RR interval of 853 ± 152 ms, 0.25 ± 0.11 mV at the RR interval in the conducted APB of 545 ± 133 ms (P = .0018), and 0.19 ± 0.08 mV at the RR interval of 1146 ± 314 ms (P = .3102). The clinical characteristics were not different between patients with and without tachycardia-dependent augmentation of J waves. Augmentation of J waves was confirmed by the electrophysiology study: 0.28 ± 0.12 mV vs 0.42 ± 0.11 mV at baseline and in the beats of atrial stimulation, respectively (P = .0001). However, no bradycardia-dependent augmentation (>0.05 mV) was observed. Such tachycardia-dependent augmentation can represent depolarization abnormality rather than repolarization abnormality.
  
  
  CONCLUSIONS
  J waves in a general patient population were augmented at shorter RR intervals, but not at prolonged RR intervals. Mechanistically, conduction delay is most likely responsible for this.
authors.affiliation: Tachikawa Medical Center, Niigata University, Nagaoka, Niigata, Japan. Electronic address: aizaways@med.niigata-u.ac.jp.
authors.forename: Yoshifusa
authors.initials: Y
authors.lastname: Aizawa
authors.affiliation: Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Sato
authors.affiliation: Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kitazawa
authors.affiliation: Department of Cardiology Keio University, Tokyo, Japan.
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Aizawa
authors.affiliation: Department of Cardiology Keio University, Tokyo, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Takatsuki
authors.affiliation: Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Oda
authors.affiliation: Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Okabe
authors.affiliation: Department of Cardiology Keio University, Tokyo, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D013610:Tachycardia / Q000453:epidemiology* / Q000503:physiopathology; D014693:Ventricular Fibrillation
keywords: Conduction delay; Early repolarization; J waves; Rate dependency