Dynamicity of the J-wave in idiopathic ventricular fibrillation with a special reference to pause-dependent augmentation of the J-wave

Objectives: This study evaluated the pause-dependency of the J-wave to characterize this phenomenon in idiopathic ventricular fibrillation (VF). Background: The J-wave can be found in apparently healthy subjects and in patients at risk for sudden cardiac death, and risk stratification is therefore needed. Methods: Forty patients with J-wave-associated idiopathic VF were studied for J waves with special reference concerning pause-dependent augmentation. J waves were defined as those <0.1 mV above the isoelectric line and were compared with 76 non-VF patients of comparable age and sex. Results: The J-wave was larger in patients with idiopathic VF than in the controls: 0.360 ± 0.181 mV versus 0.192 ± 0.064 mV (p = 0.0011). J waves were augmented during storms of VF (n = 9 [22.5%]), which was controlled by isoproterenol; they disappeared within weeks in 5 patients. In addition, sudden prolongation of the R-R interval was observed in 27 patients induced by benign arrhythmia, and 15 patients (55.6%) demonstrated pause-dependent augmentation (from 0.391 ± 0.126 mV to 0.549 ± 0.220 mV; p < 0.0001). In the other 12 experimental subjects and in the 76 control subjects, J waves remained unchanged. Pause-dependent augmentation of J waves was detected in 55.6% (sensitivity) but was specific (100%) in the patients with idiopathic VF with high positive (100%) and negative (86.4%) predictive values. Conclusions: Pause-dependent augmentation of J waves was confirmed in about one-half of the patients with idiopathic VF after sudden R-R prolongation. Such dynamicity of J waves was specific to idiopathic VF and may be used for risk stratification.