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CLINICAL RESEARCH: HEART RHYTHM DISORDER

J-Point Elevation in Survivors of Primary Ventricular Fibrillation and Matched Control Subjects

Incidence and Clinical Significance

Raphael Rosso, MD^_*, Evgeni Kogan, MD^_*, Bernard Belhassen, MD^_*, Uri Rozovski, MD^_*, Melvin M. Scheinman, MD, David Zeltser, MD^_*, Amir Halkin, MD^_*, Arie Steinvil, MD^_*, Karin Heller, MD^_*, Michael Glikson, MD, Amos Katz, MD and Sami Viskin, MD^_*,_*

^_* Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Soroka Medical Center and Ben Gurion University, Beer-Sheva, Israel
University of California San Francisco, San Francisco, California

Manuscript received April 21, 2008; revised manuscript received July 7, 2008, accepted July 14, 2008.

^_* Reprint requests and correspondence: Dr. Sami Viskin, Tel Aviv Medical Center, Weizman 6, Tel Aviv 64239, Israel (Email: saviskin{at}tasmc.health.gov.il).

Objectives: The purpose of this study was to determine whether J-point elevation is a marker of arrhythmic risk.

Background: J-point elevation has been considered an innocent finding among healthy young individuals (the "early repolarization" pattern). However, this electrocardiogram (ECG) finding is increasingly being associated with idiopathic ventricular fibrillation (VF).

Methods: In a case-control study, the ECG of 45 patients with idiopathic VF were compared with those of 124 age- and gender-matched control subjects and with those of 121 young athletes. We measured the height of J-point and ST-segment elevation and counted the presence of slurring in the terminal portion of the R-wave.

Results: J-point elevation was more common among patients with idiopathic VF than among matched control subjects (42% vs. 13%, p = 0.001). This was true for J-point elevation in the inferior leads (27% vs. 8%, p = 0.006) and for J-point elevation in leads I to aVL (13% vs. 1%, p = 0.009). J-point elevation in V₄ to V₆ occurred with equal frequency among patients and matched control subjects (6.7% vs. 7.3%, p = 0.86). Male subjects had J-point elevation more often than female subjects and young athletes had J-point elevation more often than healthy adults but less often than patients with idiopathic VF. The presence of ST-segment elevation or QRS slurring did not add diagnostic value to the presence of J-point elevation.

Conclusions: J-point elevation is found more frequently among patients with idiopathic VF than among healthy control subjects. The frequency of J-point elevation among young athletes is intermediate (higher than among healthy adults but lower than among patients with idiopathic VF).

Key Words: electrocardiogram • polymorphic ventricular tachycardia • ventricular fibrillation

Abbreviations and Acronyms   CI = confidence interval   ECG = electrocardiogram   OR = odds ratio   VF = ventricular fibrillation

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