title: Variants of Brugada Syndrome and Early Repolarization Syndrome: An Expanded Concept of J-Wave Syndrome.
abstract: BACKGROUND
  The role of J-waves in the pathogenesis of ventricular fibrillation (VF) occurring in structurally normal hearts is important.
  
  
  METHODS
  We evaluated 127 patients who received an implantable cardioverter-defibrillator (ICD) for Brugada syndrome (BS, n = 53), early repolarization syndrome (ERS, n = 24), and patients with unknown or deferred diagnosis (n = 50). Electrocardiography (ECG), clinical characteristics, and ICD data were analyzed.
  
  
  RESULTS
  J-waves were found in 27/50 patients with VF of unknown/deferred diagnosis. The J-waves were reminiscent of those seen in BS or ERS, and this subgroup of patients was termed variants of ERS and BS (VEB). In 12 VEB patients, the J/ST/T-wave morphology was coved, although amplitudes were <0.2 mV. In 15 patients, noncoved-type J/ST/T-waves were present in the right precordial leads. In the remaining 23 patients, no J-waves were identified. VEB patients exhibited clinical characteristics similar to those of BS and ERS patients. Phenotypic transition and overlap were observed among patients with BS, ERS, and VEB. Twelve patients with BS had background inferolateral ER, while five ERS patients showed prominent right precordial J-waves. Patients with this transient phenotype overlap showed a significantly lower shock-free survival than the rest of the study patients.
  
  
  CONCLUSIONS
  VEB patients demonstrate ECG phenotype similar to but distinct from those of BS and ERS. The spectral nature of J-wave morphology/distribution and phenotypic transition/overlap suggest a common pathophysiologic background in patients with VEB, BS, and ERS. Prognostic implication of these ECG variations requires further investigation.
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Sung-Hwan
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Gi-Byoung
authors.initials: GB
authors.lastname: Nam
authors.affiliation: Department of Internal Medicine, College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Korea.
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.affiliation: Department of Internal Medicine, College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Korea.
authors.forename: Hyung Oh
authors.initials: HO
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, College of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Kee-Joon
authors.initials: KJ
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Korea.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
authors.affiliation: Department of Internal Medicine, College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Korea.
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
authors.affiliation: Department of Internal Medicine, College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Korea.
authors.forename: Moon-Hyoung
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Korea.
authors.forename: Sung Soon
authors.initials: SS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, College of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea.
authors.forename: Young Keun
authors.initials: YK
authors.lastname: On
authors.affiliation: Department of Internal Medicine, College of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea.
authors.forename: June Soo
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Il-Young
authors.initials: IY
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Eue-Keun
authors.initials: EK
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Seil
authors.initials: S
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Yun-Shik
authors.initials: YS
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, College of Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Jong Il
authors.initials: JI
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, College of Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Sang Weon
authors.initials: SW
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, College of Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Yong-Seog
authors.initials: YS
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Man Young
authors.initials: MY
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, College of Medicine, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Hong Euy
authors.initials: HE
authors.lastname: Lim
authors.affiliation: Department of Internal Medicine, College of Medicine, Catholic University of Daegu, Daegu, Korea.
authors.forename: Young-Soo
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, College of Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Yongkeun
authors.initials: Y
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, College of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jun
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Chonbuk National University Hospital, Jeonju, Korea.
authors.forename: Kyoung-Suk
authors.initials: KS
authors.lastname: Rhee
authors.affiliation: Department of Internal Medicine, College of Medicine, Hanseo Hospital, Busan, Korea.
authors.forename: Dong-Il
authors.initials: DI
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, College of Medicine, Hanmaeum General Hospital, Jeju, Korea.
authors.forename: Dae Kyoung
authors.initials: DK
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, College of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: You-Ho
authors.initials: YH
authors.lastname: Kim
mesh_terms: D053840:Brugada Syndrome / Q000145:classification* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D000072657:ST Elevation Myocardial Infarction / Q000145:classification* / Q000175:diagnosis*; D012680:Sensitivity and Specificity
keywords: J-waves; early repolarization; electrocardiography; sudden cardiac death; ventricular fibrillation