Intracardiac J-point elevation before the onset of polymorphic ventricular tachycardia and ventricular fibrillation in patients with an implantable cardioverter-defibrillator

Larisa G. Tereshchenko, Aaron McCabe, Lichy Han, Sanjoli Sur, Timothy Huang, Joseph E. Marine, Alan Cheng, David D. Spragg, Sunil Sinha, Hugh Calkins, Kenneth Stein, Gordon F. Tomaselli, Ronald D. Berger

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: The clinical importance of the J-point elevation on electrocardiogram is controversial. Objective: To study intracardiac J-point amplitude before ventricular arrhythmia. Methods: Baseline 12-lead electrocardiogram and far-field right ventricular intracardiac implantable cardioverter-defibrillator electrograms were recorded at rest in 494 patients (mean age 60.4 ± 13.1 years; 360 [72.9%] men) with structural heart disease (278 [56.3%] ischemic cardiomyopathy) who received primary (463 [93.9%] patients) or secondary prevention implantable cardioverter-defibrillator. Ten-second intracardiac far-field electrograms before the onset of arrhythmia were compared with the baseline. The J-point amplitude was measured on the baseline 12-lead surface electrocardiogram and the intracardiac far-field electrogram. The relative J-point amplitude was calculated as the ratio of J-point amplitude to peak-to-peak R-wave. Results: The paired t test showed that the relative intracardiac J-point amplitude was significantly higher before polymorphic ventricular tachycardia/ventricular fibrillation (VF) onset (0.28 ± 0.08 vs -0.19 ± 0.39; P =.012) than at baseline. In a mixed-effects logistic regression model, adjusted for multiple episodes per patient, each 10% increase in relative J-point amplitude increased the odds of having ventricular tachycardia/VF by 13% (odds ratio 1.13 [95% confidence interval 1.07-1.19]; P <.0001) and increased the odds of having polymorphic ventricular tachycardia/VF by 27% (odds ratio 1.27 [95% confidence interval 1.11-1.46]; P =.001). Conclusions: The relative intracardiac J-point amplitude is augmented immediately before the onset of polymorphic ventricular tachycardia/VF in patients with structural heart disease.

Original languageEnglish (US)
Pages (from-to)1594-1602
Number of pages9
JournalHeart Rhythm
Volume9
Issue number10
DOIs
StatePublished - Oct 1 2012
Externally publishedYes

Fingerprint

Implantable Defibrillators
Ventricular Fibrillation
Ventricular Tachycardia
Electrocardiography
Cardiac Arrhythmias
Heart Diseases
Logistic Models
Odds Ratio
Confidence Intervals
Secondary Prevention
Cardiomyopathies
Lead

Keywords

  • Electrocardiography
  • Implantable cardioverter-defibrillator
  • Intracardiac electrogram
  • J-point elevation
  • Ventricular arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Intracardiac J-point elevation before the onset of polymorphic ventricular tachycardia and ventricular fibrillation in patients with an implantable cardioverter-defibrillator. / Tereshchenko, Larisa G.; McCabe, Aaron; Han, Lichy; Sur, Sanjoli; Huang, Timothy; Marine, Joseph E.; Cheng, Alan; Spragg, David D.; Sinha, Sunil; Calkins, Hugh; Stein, Kenneth; Tomaselli, Gordon F.; Berger, Ronald D.

In: Heart Rhythm, Vol. 9, No. 10, 01.10.2012, p. 1594-1602.

Research output: Contribution to journalArticle

Tereshchenko, LG, McCabe, A, Han, L, Sur, S, Huang, T, Marine, JE, Cheng, A, Spragg, DD, Sinha, S, Calkins, H, Stein, K, Tomaselli, GF & Berger, RD 2012, 'Intracardiac J-point elevation before the onset of polymorphic ventricular tachycardia and ventricular fibrillation in patients with an implantable cardioverter-defibrillator', Heart Rhythm, vol. 9, no. 10, pp. 1594-1602. https://doi.org/10.1016/j.hrthm.2012.06.036
Tereshchenko, Larisa G. ; McCabe, Aaron ; Han, Lichy ; Sur, Sanjoli ; Huang, Timothy ; Marine, Joseph E. ; Cheng, Alan ; Spragg, David D. ; Sinha, Sunil ; Calkins, Hugh ; Stein, Kenneth ; Tomaselli, Gordon F. ; Berger, Ronald D. / Intracardiac J-point elevation before the onset of polymorphic ventricular tachycardia and ventricular fibrillation in patients with an implantable cardioverter-defibrillator. In: Heart Rhythm. 2012 ; Vol. 9, No. 10. pp. 1594-1602.
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abstract = "Background: The clinical importance of the J-point elevation on electrocardiogram is controversial. Objective: To study intracardiac J-point amplitude before ventricular arrhythmia. Methods: Baseline 12-lead electrocardiogram and far-field right ventricular intracardiac implantable cardioverter-defibrillator electrograms were recorded at rest in 494 patients (mean age 60.4 ± 13.1 years; 360 [72.9{\%}] men) with structural heart disease (278 [56.3{\%}] ischemic cardiomyopathy) who received primary (463 [93.9{\%}] patients) or secondary prevention implantable cardioverter-defibrillator. Ten-second intracardiac far-field electrograms before the onset of arrhythmia were compared with the baseline. The J-point amplitude was measured on the baseline 12-lead surface electrocardiogram and the intracardiac far-field electrogram. The relative J-point amplitude was calculated as the ratio of J-point amplitude to peak-to-peak R-wave. Results: The paired t test showed that the relative intracardiac J-point amplitude was significantly higher before polymorphic ventricular tachycardia/ventricular fibrillation (VF) onset (0.28 ± 0.08 vs -0.19 ± 0.39; P =.012) than at baseline. In a mixed-effects logistic regression model, adjusted for multiple episodes per patient, each 10{\%} increase in relative J-point amplitude increased the odds of having ventricular tachycardia/VF by 13{\%} (odds ratio 1.13 [95{\%} confidence interval 1.07-1.19]; P <.0001) and increased the odds of having polymorphic ventricular tachycardia/VF by 27{\%} (odds ratio 1.27 [95{\%} confidence interval 1.11-1.46]; P =.001). Conclusions: The relative intracardiac J-point amplitude is augmented immediately before the onset of polymorphic ventricular tachycardia/VF in patients with structural heart disease.",
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T1 - Intracardiac J-point elevation before the onset of polymorphic ventricular tachycardia and ventricular fibrillation in patients with an implantable cardioverter-defibrillator

AU - Tereshchenko, Larisa G.

AU - McCabe, Aaron

AU - Han, Lichy

AU - Sur, Sanjoli

AU - Huang, Timothy

AU - Marine, Joseph E.

AU - Cheng, Alan

AU - Spragg, David D.

AU - Sinha, Sunil

AU - Calkins, Hugh

AU - Stein, Kenneth

AU - Tomaselli, Gordon F.

AU - Berger, Ronald D.

PY - 2012/10/1

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N2 - Background: The clinical importance of the J-point elevation on electrocardiogram is controversial. Objective: To study intracardiac J-point amplitude before ventricular arrhythmia. Methods: Baseline 12-lead electrocardiogram and far-field right ventricular intracardiac implantable cardioverter-defibrillator electrograms were recorded at rest in 494 patients (mean age 60.4 ± 13.1 years; 360 [72.9%] men) with structural heart disease (278 [56.3%] ischemic cardiomyopathy) who received primary (463 [93.9%] patients) or secondary prevention implantable cardioverter-defibrillator. Ten-second intracardiac far-field electrograms before the onset of arrhythmia were compared with the baseline. The J-point amplitude was measured on the baseline 12-lead surface electrocardiogram and the intracardiac far-field electrogram. The relative J-point amplitude was calculated as the ratio of J-point amplitude to peak-to-peak R-wave. Results: The paired t test showed that the relative intracardiac J-point amplitude was significantly higher before polymorphic ventricular tachycardia/ventricular fibrillation (VF) onset (0.28 ± 0.08 vs -0.19 ± 0.39; P =.012) than at baseline. In a mixed-effects logistic regression model, adjusted for multiple episodes per patient, each 10% increase in relative J-point amplitude increased the odds of having ventricular tachycardia/VF by 13% (odds ratio 1.13 [95% confidence interval 1.07-1.19]; P <.0001) and increased the odds of having polymorphic ventricular tachycardia/VF by 27% (odds ratio 1.27 [95% confidence interval 1.11-1.46]; P =.001). Conclusions: The relative intracardiac J-point amplitude is augmented immediately before the onset of polymorphic ventricular tachycardia/VF in patients with structural heart disease.

AB - Background: The clinical importance of the J-point elevation on electrocardiogram is controversial. Objective: To study intracardiac J-point amplitude before ventricular arrhythmia. Methods: Baseline 12-lead electrocardiogram and far-field right ventricular intracardiac implantable cardioverter-defibrillator electrograms were recorded at rest in 494 patients (mean age 60.4 ± 13.1 years; 360 [72.9%] men) with structural heart disease (278 [56.3%] ischemic cardiomyopathy) who received primary (463 [93.9%] patients) or secondary prevention implantable cardioverter-defibrillator. Ten-second intracardiac far-field electrograms before the onset of arrhythmia were compared with the baseline. The J-point amplitude was measured on the baseline 12-lead surface electrocardiogram and the intracardiac far-field electrogram. The relative J-point amplitude was calculated as the ratio of J-point amplitude to peak-to-peak R-wave. Results: The paired t test showed that the relative intracardiac J-point amplitude was significantly higher before polymorphic ventricular tachycardia/ventricular fibrillation (VF) onset (0.28 ± 0.08 vs -0.19 ± 0.39; P =.012) than at baseline. In a mixed-effects logistic regression model, adjusted for multiple episodes per patient, each 10% increase in relative J-point amplitude increased the odds of having ventricular tachycardia/VF by 13% (odds ratio 1.13 [95% confidence interval 1.07-1.19]; P <.0001) and increased the odds of having polymorphic ventricular tachycardia/VF by 27% (odds ratio 1.27 [95% confidence interval 1.11-1.46]; P =.001). Conclusions: The relative intracardiac J-point amplitude is augmented immediately before the onset of polymorphic ventricular tachycardia/VF in patients with structural heart disease.

KW - Electrocardiography

KW - Implantable cardioverter-defibrillator

KW - Intracardiac electrogram

KW - J-point elevation

KW - Ventricular arrhythmia

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