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Nagase S, Oka S, Kamakura T, Aiba T, Morita H, Kusano K. Local dispersion of repolarization in the occurrence of ventricular fibrillation in Brugada syndrome: Possibility of phase 2 reentry? Pacing Clin Electrophysiol 2024. [PMID: 38214176 DOI: 10.1111/pace.14917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024]
Abstract
To date, there have been no reports of recording epicardial electrograms at the onset of spontaneous ventricular fibrillation (VF) in patients with Brugada syndrome (BrS). In the case of BrS, unipolar and bipolar electrogram recording on the right ventricular epicardium revealed that dispersion of repolarization with delayed potential was associated with spontaneous occurrence of VF. Phase 2 reentry associated with shortening and dispersion of action potential could have been recorded for the first time in BrS. Epicardial unipolar mapping can guide accurate and appropriate ablation for the elimination of arrhythmia substrate in J wave syndrome.
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Affiliation(s)
- Satoshi Nagase
- Department of Advanced Arrhythmia and Translational Medical Science, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Oka
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tsukasa Kamakura
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kengo Kusano
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Kamareddine MH, Yan GX. Ventricular repolarization dispersion: Friend or foe. Heart Rhythm 2023; 20:1637-1638. [PMID: 37597599 DOI: 10.1016/j.hrthm.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Institute for Medical Research and Lankenau Medical Center, Wynnewood, Pennsylvania; Fuwai Huazhong Hospital, Chinese Academy of Medical Sciences, Zhengzhou, P.R. China; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Zhou X, Ren L, Huang J, Zhang Y, Cai Y, Pu J. Novel SCN5A frame‑shift mutation underlying in patient with idiopathic ventricular fibrillation manifested with J wave in inferior lead and prolonged S‑wave in precordial lead. Exp Ther Med 2023; 25:287. [PMID: 37206574 PMCID: PMC10189605 DOI: 10.3892/etm.2023.11986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 02/01/2023] [Indexed: 05/21/2023] Open
Abstract
Mutations in the SCN5A gene has been recognized as resulting in a series of life-threatening arrhythmias. However, it also causes idiopathic ventricular fibrillation (IVF) with J wave in inferior leads and prolonged S-wave upstroke in precordial leads, which has not been previously reported. The present study aimed to study the mechanisms of a patient with IVF manifested with J wave in inferior leads and prolonged S-wave upstroke in precordial leads. The electrocardiograms (ECG) of the proband were recorded and genetic testing was conducted. Patch-clamp and immunocytochemical studies were performed in heterologously transfected 293 cells. The VF attacks was documented in a 55-year-old male proband with syncope episodes. 12-lead ECG shown the transient J wave in the inferior leads and prolonged S-wave upstroke in precordial V1-V3 leads in the same timeframe. Genetic analysis revealed a novel 1 base deletion (G) at position 839 in exon 2 in SCN5A gene (C280S*fs61), which causes a severe truncation of the sodium channel. The functional study revealed that in 293 cells transfected with mutant channel, no sodium current could be recorded even though the immunocytochemical experiment confirmed the truncated sodium channel existed in cytosol. The kinetics of the wild-type (WT) channel were not altered when co-transfected with C280S*fs61 mutant which suggested a haploinsufficiency effect of sodium channel in the cells. The present study identified a novel C280Sfs*61 mutation that caused the 'loss of function' of the sodium channel by haploinsufficiency mechanism. The reduced sodium channel function in the heart may cause conduction delay that may underlie the manifestation of J wave and prolonged S-wave upstroke associated with IVF.
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Affiliation(s)
- Xiaoqian Zhou
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai 100123, P.R. China
| | - Lan Ren
- Department of Cardiology, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P.R. China
| | - Jian Huang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P.R. China
| | - Yinhui Zhang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P.R. China
| | - Ying Cai
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai 100123, P.R. China
- Correspondence to: Professor Jielin Pu and Professor Ying Cai, Department of Cardiology, Shanghai East Hospital, Tongji University, 1800 Yuntai Road, Pudong, Shanghai 100123, P.R. China
| | - Jielin Pu
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai 100123, P.R. China
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P.R. China
- Correspondence to: Professor Jielin Pu and Professor Ying Cai, Department of Cardiology, Shanghai East Hospital, Tongji University, 1800 Yuntai Road, Pudong, Shanghai 100123, P.R. China
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Omondi A, Sirinvaravong N, Spears J, Sauerwein S, Taoutel R, Liskov S, Gao C, Liu T, Kowey PR, Yan GX. Marked QTc Reduction Immediately Following Direct Current Cardioversion of Atrial Fibrillation: Clinical Implications and Mechanisms. JACC Clin Electrophysiol 2022; 9:543-554. [PMID: 36752461 DOI: 10.1016/j.jacep.2022.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/12/2022] [Accepted: 10/19/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The QTc in sinus rhythm (SR) following direct current cardioversion (DCCV) of atrial fibrillation (AF) is commonly used as a baseline QTc for patients who require initiation of antiarrhythmic drugs for rhythm control. Inaccurate baseline QTc may cause drug-induced torsades de pointes. OBJECTIVES To assess time-dependent QTc changes following DCCV. METHODS We prospectively assessed QTc changes with Bazett's QTc and Fridericia's QTc formulas in 65 patients following conversion of AF to SR. Among these 65 patients, 48 underwent DCCV and 17 spontaneously converted to SR. RESULTS There was a large and statistically significant decrease in QTc in SR immediately following DCCV in 40 patients, which occurred with an abrupt reduction in heart rate postcardioversion. This finding excluded 8 patients with ventricular-paced QRS. The mean decrease from QTc in AF was 70.7 ± 37.2 milliseconds in the QTc interval for heart rate using Bazett's formula and 33.8 ± 17.9 milliseconds in the QTc interval for heart rate using Fridericia's formula at 1-minute post-DCCV. In 17 patients with spontaneous conversion from AF to SR, the QTc reduction was comparable to those in patients with DCCV. The QTc increased with time and reached a steady state at 5 minutes following conversion. Initiation of class III drugs based on the "shortened" baseline QTc following DCCV was associated with drug-induced torsades de pointes. CONCLUSIONS In patients with AF following conversion, regardless spontaneous or DCCV, the QTc shortened significantly with decreases in heart rate, likely via the mechanism of time-dependent rate adaption of ventricular repolarization. A steady-state QTc at 5-minutes following DCCV should be used as real baseline for guidance of pharmacotherapy in patients with AF.
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Affiliation(s)
- Arthur Omondi
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Natee Sirinvaravong
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Jenna Spears
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Samuel Sauerwein
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Roy Taoutel
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Steven Liskov
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Chuanyu Gao
- Fuwai Huazhong Hospital, Zhengzhou, Henan, China.
| | - Tong Liu
- Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Peter R Kowey
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gan-Xin Yan
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA; Fuwai Huazhong Hospital, Zhengzhou, Henan, China; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Shen S, Xie Y, Ju P, Li W, Zhang J, Cai R, Li R. Predictive effect of J waves on cardiac compression and clinical prognosis of esophageal tumors: a retrospective study. J Gastrointest Oncol 2022; 13:923-934. [PMID: 35837153 DOI: 10.21037/jgo-22-371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background The J wave syndromes (JWS) could be observed in patients with mediastinal tumors, though few studies have verified the statistical correlation between J waves and cardiac compression by tumors. This study aimed to investigate the relationship between J waves and cardiac compression by esophageal tumor and to compare the prediction of J waves on clinical prognosis with that of cardiac compression by esophageal tumor. Methods We enrolled 273 patients (228 males, 45 females; mean 63.8±7.5 years) with esophageal tumors admitted to Shanghai Chest Hospital between August 2016 and November 2020. The J wave was defined as a J-point elevation of ≥0.1 mV in a 12-lead electrocardiogram (ECG) and classified into multiple types. Chest computed tomography (CT) was reviewed to clarify the anatomical relationship between the heart and the esophageal tumor. The prognosis of severe cardiac events and survival status were followed up through medical history, examination records and telephone records. Results J waves were present in 141 patients among all 273 cases. The sensitivity and specificity of cardiac compression by the tumor for J waves were 78.1% and 67.3%, respectively. The odds ratio (OR) of cardiac compression by the tumor to J waves was 7.33 [95% confidence interval (CI): 4.21-12.74; P<0.001]. The Kappa coefficient between J waves and cardiac compression was 0.44±0.05. The significance association between J waves and cardiac compression was independent from other clinical variables (P<0.001). Decreased J wave amplitude was correlated with the disappearance of cardiac compression during follow-up (P=0.03). Patients with J waves had a higher risk of severe cardiac events than those without J waves (OR =2.84, 95% CI: 1.22-6.63; P=0.01). During the follow-up period, we found that the presence of J waves [hazard ratio (HR) =2.28; 95% CI: 1.35-3.84; P=0.002] and cardiac compression by the tumor (HR =2.51; 95% CI: 1.51-4.17; P<0.001) were both negatively correlated with the survival time of patients. Conclusions The presence of J waves could be used as an effective mean to predict the mechanical impact of esophageal tumor on the heart, and played an important role in predicting the survival of patients.
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Affiliation(s)
- Songcui Shen
- Department of Cardiac Function, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yichen Xie
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Pengliang Ju
- Department of Cardiac Function, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Wenzhao Li
- Department of Cardiac Function, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jiayuan Zhang
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Ruxin Cai
- Department of Radiotherapy, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Ruogu Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
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Ooi YS, Amer M, Qi D, Yang Z, Gao C, Yan GX. Delta QRS distinguishes I to -mediated J waves from pseudo J waves produced by conduction delay on body surface electrocardiographic. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1832-1841. [PMID: 34498737 DOI: 10.1111/pace.14359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 06/03/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND On surface electrocardiographic (ECGs), it is difficult to differentiate Ito -mediated J waves, a repolarization phenomenon seen in J wave syndromes (JWS) from terminal QRS deflections that mimic J waves (pseudo J waves) in intraventricular conduction delay (IVCD), an abnormality in depolarization. We hypothesize that the difference between the "maximum QRS duration" inclusive of J point or terminal QRS deflections and the minimum QRS duration identified across a 12-lead ECG is significantly larger in Ito -mediated J waves, and can serve as a marker to make this distinction. METHODS A retrospective analysis was performed on adults with ECGs consisting of one of the four following manifestations: J waves associated with hypothermia and early repolarization, and pseudo J waves associated with right bundle branch block (RBBB) and non-specific intraventricular conduction delay (NS-IVCD). All ECGs were assessed individually and the maximum and minimum discrete QRS deflections on 12-lead tracings, defined as "QRSmax " and QRSmin , were identified. The difference between "QRSmax " and QRSmin , designated as ∆QRS, was calculated and compared across the studied populations. RESULTS A total of 60 patients consisting of 15 patients in each arm were included in the study. ΔQRS was significantly larger in the hypothermia and early repolarization groups, compared to RBBB and NS-IVCD (p < .0001), with the following mean ∆QRS: hypothermia 54.3 ± 13.7 ms, early repolarization pattern 47.3 ± 15.3 ms, RBBB 19.3 ± 6.5 ms, and NS-IVCD 16.0 ± 6.6 ms. CONCLUSION ∆QRS may serve as a reliable ECG parameter for distinguishing Ito -mediated J waves from pseudo J waves produced by delayed intraventricular conduction.
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Affiliation(s)
| | - Mostafa Amer
- Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Datun Qi
- Fuwai Huazhong Hospital, Zhengzhou, Henan, PR China.,Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Zhen Yang
- General Hospital of Ningxia Medical University, PR China
| | - Chuanyu Gao
- Fuwai Huazhong Hospital, Zhengzhou, Henan, PR China
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, Pennsylvania, USA.,Fuwai Huazhong Hospital, Zhengzhou, Henan, PR China.,Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.,Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Chen XM, Fan J, Cheng YJ, Ji CC, Yao FJ, Wu SH. Autonomic Influences Related to Early Repolarization in Patients Without Structural Heart Disease. J Cardiovasc Transl Res 2020; 13:970-976. [PMID: 32557319 DOI: 10.1007/s12265-020-10033-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
This cross-sectional study focused on the association between heart rate variability (HRV) and early repolarization pattern (ERP). It included 1236 patients categorized into three groups: ERP type 1: J-point elevation with notched/slurred QRS; ERP type 2: ST elevation without dominant J-wave; and non-ERP group. Analyzing time-domain indexes include standard deviation of NN (normal-to-normal) RR intervals (SDNN), root mean square of successive difference in NN RR intervals (RMSSD), and proportion of consecutive NN intervals that differ by more than 50 ms (PNN50), there were significant differences between any two groups (all P < 0.01). All time-domain indexes showed: ERP type 2 > ERP type 1 > non-ERP. Multivariate logistic regression analysis revealed that SDNN at nighttime and gender were independently associated with the maximum magnitude of J-point elevation ≧ 0.2 mV. The findings strongly suggested that based on electrocardiogram characteristics, parasympathetic tone denoted by HRV may be related to different types of ERP.
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Affiliation(s)
- Xu-Miao Chen
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Jun Fan
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Yun-Jiu Cheng
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Cheng-Cheng Ji
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Feng-Juan Yao
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Su-Hua Wu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. .,Key Laboratory of Assisted Circulation, NHC, Guangzhou, China.
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Wang X, Zhang L, Gao C, Zhu J, Yang X. Tpeak-Tend/QT interval predicts ST-segment resolution and major adverse cardiac events in acute ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention. Medicine (Baltimore) 2018; 97:e12943. [PMID: 30412109 PMCID: PMC6221564 DOI: 10.1097/md.0000000000012943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Elevated ST-segment and increased Tpeak-Tend interval (Tp-e) were prognostic predictors in major adverse cardiac events (MACEs) in ST-segment elevation myocardial infarction (STEMI). The electrophysiologic relationship between them during percutaneous coronary intervention (PCI) needs to elucidate.Patients with STEMI admitted to hospital were prospectively evaluated. ST-segment resolution (STR) (defined as ≥50% reduction as the complete-STR [CSTR] group, <50% as incomplete-STR [ISTR] group), Tp-e interval, and ratio of Tp-e to QT interval (Tp-e/QT) were measured, calculated and analyzed with MACEs.Tp-ec interval (corrected Tp-e interval, P < .001) and Tp-e/QT ratio (P < .001) were significantly increased by myocardial infarction and partly recovered post-PCI. Patients with ISTR showed more increased Tp-ec interval (P < .001) and Tp-e/QT ratio (P < .001) than those in CSTR groups post-PCI. In multivariate analysis and receiver operating characteristic curves analysis, Tp-e/QT was an independent and strongest predictor for STR. STR and electrocardiogram parameters with a cutoff value for predicting STR showed prognostic value for MACE in STEMI in Kaplan-Meier survival analysis.Both STR and change of Tp-e parameters were not only predictors of arrhythmia, but also prognostic factors of MACE in patients with STEMI after PCI.
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Electrocardiographic J wave: Early repolarization, Brugada wave, and conduction delay. Heart Rhythm 2018; 16:81-82. [PMID: 30118884 DOI: 10.1016/j.hrthm.2018.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Indexed: 11/21/2022]
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Sicouri S, Antzelevitch C. Mechanisms Underlying the Actions of Antidepressant and Antipsychotic Drugs That Cause Sudden Cardiac Arrest. Arrhythm Electrophysiol Rev 2018; 7:199-209. [PMID: 30416734 PMCID: PMC6141916 DOI: 10.15420/aer.2018.29.2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/19/2018] [Indexed: 12/18/2022] Open
Abstract
A number of antipsychotic and antidepressant drugs are known to increase the risk of ventricular arrhythmias and sudden cardiac death. Based largely on a concern over the development of life-threatening arrhythmias, a number of antipsychotic drugs have been temporarily or permanently withdrawn from the market or their use restricted. While many antidepressants and antipsychotics have been linked to QT prolongation and the development of torsade de pointes arrhythmias, some have been associated with a Brugada syndrome phenotype and the development of polymorphic ventricular arrhythmias. This article examines the arrhythmic liability of antipsychotic and antidepressant drugs capable of inducing long QT and/or Brugada syndrome phenotypes. The goal of this article is to provide an update on the ionic and cellular mechanisms thought to be involved in, and the genetic and environmental factors that predispose to, the development of cardiac arrhythmias and sudden cardiac death among patients taking antidepressant and antipsychotic drugs that are in clinical use.
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Affiliation(s)
- Serge Sicouri
- Lankenau Institute for Medical ResearchWynnewood, PA, USA
| | - Charles Antzelevitch
- Lankenau Institute for Medical ResearchWynnewood, PA, USA
- Lankenau Heart InstituteWynnewood, PA
- Sidney Kimmel Medical College of Thomas Jefferson UniversityPhiladelphia, PA, USA
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Abstract
INTRODUCTION Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome characterized by ST-segment elevation in right precordial ECG leads and associated with sudden cardiac death in young adults. The ECG manifestations of BrS are often concealed but can be unmasked by sodium channel blockers and fever. Areas covered: Implantation of a cardioverter defibrillator (ICD) is first-line therapy for BrS patients presenting with prior cardiac arrest or documented VT. A pharmacological approach to therapy is recommended in cases of electrical storm, as an adjunct to ICD and as preventative therapy. The goal of pharmacological therapy is to produce an inward shift to counter the genetically-induced outward shift of ion channel current flowing during the early phases of the ventricular epicardial action potential. This is accomplished by augmentation of ICa using □□adrenergic agents or phosphodiesterase III inhibitors or via inhibition of Ito. Radiofrequency ablation of the right ventricular outward flow tract epicardium is effective in suppressing arrhythmogenesis in BrS patients experiencing frequent appropriate ICD-shocks. Expert commentary: Understanding of the pathophysiology and approach to therapy of BrS has advanced considerably in recent years, but there remains an urgent need for development of cardio-selective and ion-channel-specific Ito blockers for treatment of BrS.
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Affiliation(s)
- Mariana Argenziano
- a Cardiovascular Research , Lankenau Institute for Medical Research , Wynnewood , PA , USA
| | - Charles Antzelevitch
- a Cardiovascular Research , Lankenau Institute for Medical Research , Wynnewood , PA , USA.,b Cardiovascular Research , Lankenau Heart Institute , Wynnewood , PA , USA.,c Department of Medicine and Pharmacology and Experimental Therapeutics , Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia , PA , USA
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12
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Hayashi H, Wu Q, Horie M. The relationship between J waves and contact of lung cancer with the heart. Ann Noninvasive Electrocardiol 2017; 22:e12433. [PMID: 28299892 PMCID: PMC6931450 DOI: 10.1111/anec.12433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/05/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND J waves result mainly from an increased density of transient outward current (Ito ). Mechanical stretch to the heart activates multiple signal transduction pathways, in which Ito may be involved. The purpose of this study was to test the hypothesis that mechanical contact of lung cancer with the heart may manifest J waves. METHODS We reviewed 12-lead electrocardiograms to examine whether J waves were associated with contact of lung cancer with the heart. J waves were defied as an elevation of ≥0.1 mV at the junction between QRS complex and ST segment with either notching or slurring morphology. The locational interaction between lung cancer and the heart was determined by computed tomography image. RESULTS A total of 264 patients (176 men; mean 68.5 ± 10.7 years) with lung cancer were evaluated. The prevalence of J waves was 25.4% in the total population. J waves were present in 40 of 44 (90.9%) patients with the contact. In contrast, J waves were present in 25 of 220 (11.4%) patients without the contact. The sensitivity and specificity of the contact for J waves were 90.9% and 88.6%, respectively. The odds ratio of the contact with the heart to the presence of J waves was 78 (95% confidence interval 25.7-236.4). The appearance of J waves that coincided with the development of lung cancer was observed in 12 patients. CONCLUSION The presence of J waves was associated with the contact of lung cancer with the heart.
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Affiliation(s)
- Hideki Hayashi
- Department of Cardiovascular and Respiratory MedicineShiga University of Medical ScienceOtsu CityShigaJapan
| | - Qi Wu
- Department of Cardiovascular and Respiratory MedicineShiga University of Medical ScienceOtsu CityShigaJapan
| | - Minoru Horie
- Department of Cardiovascular and Respiratory MedicineShiga University of Medical ScienceOtsu CityShigaJapan
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Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AA. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. Europace 2017; 19:665-694. [PMID: 28431071 PMCID: PMC5834028 DOI: 10.1093/europace/euw235] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Michael J. Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester,Minnesota
| | - Martin Borggrefe
- 1st Department of Medicine–Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Jihong Guo
- Division of Cardiology, Peking University of People's Hospital, Beijing, China
| | - Ihor Gussak
- Rutgers University, New Brunswick, New Jersey
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Minoru Horie
- Shiga University of Medical Sciences, Ohtsu, Shiga, Japan
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, and Department of Internal Medicine, University of Ulsan College of Medicine Seoul, Seoul, Korea
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur A.M. Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands and Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
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14
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Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AA. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. J Arrhythm 2016; 32:315-339. [PMID: 27761155 PMCID: PMC5063270 DOI: 10.1016/j.joa.2016.07.002] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, PA, United States
| | - Michael J. Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, United States
| | - Martin Borggrefe
- 1st Department of Medicine–Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Jihong Guo
- Division of Cardiology, Peking University of People׳s Hospital, Beijing, China
| | - Ihor Gussak
- Rutgers University, New Brunswick, NJ, United States
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Minoru Horie
- Shiga University of Medical Sciences, Ohtsu, Shiga, Japan
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Gi-Byoung Nam
- Heart Institute, Asian Medical Center, and Department of Internal Medicine, University of Ulsan College of Medicine Seoul, Seoul, South Korea
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur A.M. Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands
- Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Saudi Arabia
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15
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Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AAM. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. Heart Rhythm 2016; 13:e295-324. [PMID: 27423412 PMCID: PMC5035208 DOI: 10.1016/j.hrthm.2016.05.024] [Citation(s) in RCA: 222] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Indexed: 12/16/2022]
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Michael J Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester,Minnesota
| | - Martin Borggrefe
- 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Jihong Guo
- Division of Cardiology, Peking University of People's Hospital, Beijing, China
| | - Ihor Gussak
- Rutgers University, New Brunswick, New Jersey
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Minoru Horie
- Shiga University of Medical Sciences, Ohtsu, Shiga, Japan
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, and Department of Internal Medicine, University of Ulsan College of Medicine Seoul, Seoul, Korea
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands and Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
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16
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Liu T, Zheng J, Yan GX. J Wave Syndromes: History and Current Controversies. Korean Circ J 2016; 46:601-609. [PMID: 27721848 PMCID: PMC5054169 DOI: 10.4070/kcj.2016.46.5.601] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 11/11/2022] Open
Abstract
The concept of J wave syndromes was first proposed in 2004 by Yan et al for a spectrum of electrocardiographic (ECG) manifestations of prominent J waves that are associated with a potential to predispose affected individuals to ventricular fibrillation (VF). Although the concept of J wave syndromes is widely used and accepted, there has been tremendous debate over the definition of J wave, its ionic and cellular basis and arrhythmogenic mechanism. In this review article, we attempted to discuss the history from which the concept of J wave syndromes (JWS) is evolved and current controversies in JWS.
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Affiliation(s)
- Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jifeng Zheng
- Department of cardiology, The Second Hospital of Jiaxing, Jiaxing, China
| | - Gan-Xin Yan
- Lankenau Institute for Medical Research and Lankenau Medical Center, Wynnewood, Pennsylvania, USA.; The First Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, China
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17
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Chen XM, Ji CC, Cheng YJ, Liu LJ, Zhu WQ, Huang Y, Chen WY, Wu SH. The Role of the Ratio of J-Point Elevation Magnitude and R-Wave Amplitude on the Same ECG Lead in the Risk Stratification of Subjects With Early Repolarization Pattern. Clin Cardiol 2016; 39:678-683. [PMID: 27599368 DOI: 10.1002/clc.22587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/28/2016] [Accepted: 07/31/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Just as high-risk populations for cardiac arrest exist in patients with Brugada syndrome or long QT syndrome, high-risk and low-risk populations for cardiac arrest also exist in patients with early repolarization pattern (ERP). HYPOTHESIS Electrocardiographic (ECG) characteristics can aid the risk stratification of patients with ERP. METHODS Electrocardiographic parameters such as magnitude of J-point elevation and J/R ratio were measured. The magnitude of J-point elevation, leads with J points elevated, J/R ratio, morphology of the ST segment, and QT/QTc interval were used in comparative analysis in 2 groups: 57 patients with ERP and cardiac arrest (cardiac arrest group) and 100 patients with ERP but without cardiac arrest (control group). RESULTS There was no statistical difference in clinical characteristics of the 2 groups. The J/R ratio in the cardiac arrest group was significantly higher than in the control group (26.8% ± 18.1% vs 16.3% ± 10.3%, respectively; P < 0.001) and the proportion of horizontal/descending ST segments (70.2%) was significantly higher than in the control group (29.0%), but the proportion of ascending/upsloping ST segments (29.8%) was significantly lower than in the control group (71.0%; P < 0.001). Multivariate logistic regression revealed that higher J/R ratio and horizontal/descending ST segment were independently associated with increased risk of cardiac arrest in patients with ERP. CONCLUSIONS In patients with ERP and cardiac arrest, J/R ratios were relatively higher and mostly with horizontal/descending ST segments, suggesting that J/R ratio and ST-segment morphology may be used as indicators for risk stratification in patients with ERP.
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Affiliation(s)
- Xu-Miao Chen
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Cheng-Cheng Ji
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yun-Jiu Cheng
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Li-Juan Liu
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wei-Qi Zhu
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ying Huang
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wei-Ying Chen
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Su-Hua Wu
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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18
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Villamil-Munévar A, Alvarado J, Olaya-Sánchez A. Onda J, predictor de muerte súbita. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2015.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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19
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Cristoforetti Y, Biasco L, Giustetto C, De Backer O, Castagno D, Astegiano P, Ganzit G, Gribaudo CG, Moccetti M, Gaita F. J-wave duration and slope as potential tools to discriminate between benign and malignant early repolarization. Heart Rhythm 2016; 13:806-11. [DOI: 10.1016/j.hrthm.2015.11.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Indexed: 01/01/2023]
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20
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SHULMAN ERIC, AAGAARD PHILIP, KARGOLI FARAJ, HOCH ETHAN, BIASE LUIGIDI, FISHER JOHN, GROSS JAY, KIM SOO, PALMA EUGEN, FERRICK KEVINJ, KRUMERMAN ANDREW. The Prognostic Value of Early Repolarization with ST-Segment Elevation by Age and Gender in the Hispanic Population. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1396-404. [DOI: 10.1111/pace.12730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/22/2015] [Accepted: 07/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- ERIC SHULMAN
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - PHILIP AAGAARD
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - FARAJ KARGOLI
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - ETHAN HOCH
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - LUIGI DI BIASE
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - JOHN FISHER
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - JAY GROSS
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - SOO KIM
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - EUGEN PALMA
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - KEVIN J. FERRICK
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
| | - ANDREW KRUMERMAN
- Division of Cardiology; Department of Medicine; Montefiore Medical Center; Bronx New York
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21
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Abstract
A prominent J wave is encountered in a number of life-threatening cardiac arrhythmia syndromes, including the Brugada syndrome and early repolarization syndromes. Brugada syndrome and early repolarization syndromes differ with respect to the magnitude and lead location of abnormal J waves and are thought to represent a continuous spectrum of phenotypic expression termed J-wave syndromes. Despite two decades of intensive research, risk stratification and the approach to therapy of these 2 inherited cardiac arrhythmia syndromes are still undergoing rapid evolution. Our objective in this review is to provide an integrated synopsis of the clinical characteristics, risk stratifiers, and molecular, ionic, cellular, and genetic mechanisms underlying these 2 fascinating syndromes that have captured the interest and attention of the cardiology community in recent years.
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Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Institute for Medical Research and Lankenau Medical Center, Wynnewood, Pennsylvania; Jefferson Medical College, Philadelphia, Pennsylvania; The First Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, China
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22
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Abstract
OBJECTIVE The objective was to provide a brief history of J wave syndromes and to summarize our current understanding of their molecular, ionic, cellular mechanisms, and clinical features. We will also discuss the existing debates and further direction in basic and clinical research for J wave syndromes. DATA SOURCES The publications on key words of "J wave syndromes", "early repolarization syndrome (ERS)", "Brugada syndrome (BrS)" and "ST-segment elevation myocardial infarction (STEMI)" were comprehensively reviewed through search of the PubMed literatures without restriction on the publication date. STUDY SELECTION Original articles, reviews and other literatures concerning J wave syndromes, ERS, BrS and STEMI were selected. RESULTS J wave syndromes were firstly defined by Yan et al. in a Chinese journal a decade ago, which represent a spectrum of variable phenotypes characterized by appearance of prominent electrocardiographic J wave including ERS, BrS and ventricular fibrillation (VF) associated with hypothermia and acute STEMI. J wave syndromes can be inherited or acquired and are mechanistically linked to amplification of the transient outward current (I to )-mediated J waves that can lead to phase 2 reentry capable of initiating VF. CONCLUSIONS J wave syndromes are a group of newly highlighted clinical entities that share similar molecular, ionic and cellular mechanism and marked by amplified J wave on the electrocardiogram and a risk of VF. The clinical challenge ahead is to identify the patients with J wave syndromes who are at risk for sudden cardiac death and determine the alternative therapeutic strategies to reduce mortality.
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Affiliation(s)
- Guo-Liang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi 710061, China
| | - Lin Yang
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi 710061, China
| | - Chang-Cong Cui
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi 710061, China
| | - Chao-Feng Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi 710061, China
| | - Gan-Xin Yan
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi 710061, China
- Department of Cardiovascular Medicine, Lankenau Medical Center and Lankenau Institute of Medical Research, PA, USA
- Department of Cardiovascular Medicine, Jefferson Medical College of Thomas Jefferson University, PA, USA
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