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\begin{document}

\title{J point elevation in high precordial leads associated with risk of
ventricular fibrillation}



\author[1]{Yuki Hasegawa}%
\author[1]{Hiroshi Watanabe}%
\author[1]{Yasuhiro Ikami}%
\author[1]{Sou Otuki}%
\author[2]{Kenichi iijima}%
\author[2]{Nobue Yagihara}%
\author[2]{Daisuke Izumi}%
\author[2]{Tohru Minamino}%
\affil[1]{Niigata University Faculty of Medicine Graduate School of Medical and Dental Sciences Biological Functions and Medical Control}%
\affil[2]{Niigata University Faculty of Medicine Graduate School of Medical and Dental Sciences Biological Functions and Medical Control, Cardiovascular Biology and Medicine}%


\vspace{-1em}



  
  \date{May 24, 2024}


\begingroup
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\selectlanguage{english}
\begin{abstract}
Introduction: The significance of high precordial electrocardiograms in
idiopathic ventricular fibrillation (IVF) is unknown. Method: This study
included 50 consecutive patients (48 men; age, 42\selectlanguage{ngerman}±18 years) who had
spontaneous ventricular fibrillation not linked to structural heart
disease and received implantable cardiac defibrillator therapy. IVF was
diagnosed in 35 patients and Brugada syndrome was diagnosed in other 15
patients. Electrocardiograms in high intercostal space were compared
between 35 patients with IVF and 105 age- and sex-matched healthy
controls (patient: control ratio, 1:3). Results: The frequency of J
point elevation \selectlanguage{english}[?] 0.1mV in the 4th intercostal spaces was similar
between patients with IVF (14\%) and healthy controls (7\%). However,
the frequency of J point elevation \selectlanguage{english}[?] 0.1mV in the 3rd intercostal space
was higher in patients with IVF (40\%) than controls (11\%) (P
\textless{} 0.01). J point elevation was present only in the 3rd
intercostal space but not in the 4th intercostal space in 30\% of
patients with IVF but only in 6\% of controls (P \textless{} 0.01).
During follow up, the recurrence of ventricular fibrillation was higher
in patients with IVF who had J point elevation in the 3rd intercostal
space (36\%) and Brugada syndrome(40\%) than those with IVF who did not
have J point elevation in the 3rd intercostal space.(11\%) (P
\textless{} 0.05 for both). Conclusion: J point elevation in the 3rd
intercostal space was associated with IVF and recurrences of ventricular
fibrillation. Electrocardiogram recordings in the high intercostal space
may be useful to identify risk of sudden death.%
\end{abstract}\selectlanguage{ngerman}%



\sloppy


\emph{Key Words; J wave, ventricular fibrillation, early repolarization,
Brugada syndrome, Electrocardiogram}



\textbf{Introduction}

Ventricular fibrillation (VF) is usually associated with structural
heart disease.\textsuperscript{1} However, VF also occurs in patients
without structural heart disease.\textsuperscript{2, 3} Early
repolarization pattern or J point elevation in the inferior and/or
lateral leads of the 12-lead electrocardiogram (ECG) is associated with
pathogenesis in idiopathic ventricular fibrillation
(IVF).\textsuperscript{4-6} Furthermore, J point elevation in the right
precordial leads is also associated with IVF.\textsuperscript{7}

Brugada syndrome (BrS) is also characterized by J point elevation in the
right precordial leads and is associated with risk of ventricular
fibrillation.\textsuperscript{8} The characteristic ECG pattern is often
found only in the right precordial leads placed at second and/or third
intercostal spaces in BrS.\textsuperscript{9} However, the significance
of high precordial ECGs is unknown in IVF. In this study, we compared
high right precordial ECGs between patients with idiopathic ventricular
fibrillation and healthy controls. We also studied the association of J
point elevation in high precordial ECGs with risk of VF recurrences.

\textbf{Methods}

\textbf{Study population}

We enrolled 50 consecutive patients, between 2003 and 2018, who were
referred to our institution for resuscitated VF not linked to structural
heart disease. IVF was diagnosed in 35 patients and BrS was diagnosed in
other 15 patients. During hospitalization, all patients received
implantable cardioverter defibrillator (ICD) therapy. Patients with
structural heart disease were excluded using 12-lead ECGs, transthoracic
echocardiography, cardiac computed tomography, cardiac magnetic
resonance imaging, coronary arteriography including spasm induction, and
left ventriculography. Patients with long QT syndrome, short QT
syndrome, and catecholamine-induced polymorphic ventricular tachycardia
were also excluded. Institutional review board approval was obtained.

All patients without spontaneous type 1 Brugada ECGs received sodium
channel blocker test. BrS was diagnosed when type 1 ST-segment elevation
was observed either spontaneously or during sodium channel blocker test
in at least one right precordial lead (V1 and V2), which was placed in a
baseline standard or high (second or third) intercostal
space.\textsuperscript{10}

Twelve-lead ECGs recorded in the absence of antiarrhythmic drugs were
compared between patients with IVF and control subjects who were matched
to patients based on gender and age (patient: control ratio, 1:3).
Control subjects without cardiovascular disease or medication use were
included. Subjects with bundle branch block, intraventricular conduction
disturbances, and/or abnormal QT intervals in ECGs were excluded.

\textbf{ECG analysis}

We evaluated ECGs recorded in the 3rd and 4th ICSs in the absence of
antiarrhythmic drugs during sinus rhythm in all study subjects. J point
elevation in the right precordial leads was defined as upward/downward
notching or downward slurring with an amplitude [?] 0.1 mV at the end of
QRS to early ST segment in any of the right precordial leads (V1 and V2)
in the 3rd or 4th ICS (Figure 1). Inferolateral early repolarization
(ER) was defined as the presence of a positive J wave, which is a
slurring or notch at the QRS terminal that is [?] 0.1 mV above the
isoelectric line in [?] 2 contiguous leads in any of the inferior leads
(II, III, and aVF), the lateral leads (I, aVL, and V4--V6), or
both.\textsuperscript{4} All ECGs were manually evaluated separately by
two independent cardiologists who were blinded to the patient status (VF
patients or healthy controls).

\textbf{Clinical data}

The medical records of all VF patients were investigated for age at VF
development, sex, family history of sudden death at [?] 45 years,
patient's activity at the onset of VF, and medications. Activity status
at the onset of VF was classified as sleep if VF occurred during
sleeping, arousal at rest if VF occurred when the patient was awake
without body movement, or physical effort if VF occurred during
exertion. Electrophysiologic studies were performed on 27 patients.

After ICD implantation, all patients visited the outpatient clinic every
3--6 months for ICD interrogation. During the follow-up, patients were
considered to have VF recurrence if VF was documented by ICD
interrogation. An electrical storm was defined as three or more VF
events recorded within 24 hours. The beginning of the observation period
was the day of ICD implantation. ECGs were recorded in the 3rd and 4th
ICSs at clinic visits; however, none of the patients diagnosed with IVF
showed type 1 Brugada ECGs during the follow-up.

\textbf{Data Analysis}

The statistical analyses were performed with SPSS version 25 (IBM Inc.,
Armonk, NY). Data were expressed as the mean \selectlanguage{ngerman}± SD or number
(percentage). Differences in parameters between patients with IVF and
control subjects were analyzed using Student's \emph{t} -test for
continuous variables and by the Fisher's exact test for categorical
variables. Survival curves were constructed by the Kaplan--Meier method
and were compared using the log-rank test. A two-sided
\emph{P}\textless{}0.05 was considered statistically significant.

\textbf{Results}

\textbf{Comparisons between patients with IVF and healthy controls}

The clinical and ECG characteristics in 35 patients with IVF and 105
age- and sex-matched controls are shown in Table 1. Patients with IVF
included 33 men (94\%), and the mean age was 42 ± 18 years. The control
group included 105 healthy individuals who were matched to patients with
IVF based on sex and age (patient:control ratio, 1:3). The frequency of
J point elevations \selectlanguage{english}[?] 0.1 mV in the 4th ICS was similar between patients
with IVF (14\%) and healthy controls (7\%) (\emph{P} = 0.17). However,
the frequency of J point elevation \selectlanguage{english}[?] 0.1 mV in the 3rd ICS was higher in
patients with IVF (40\%) than controls (11\%) (Odds ratio {[}OR{]}, 5.2;
95\% confidence interval {[}CI{]}, 2.1--12.8; \emph{P} \textless{}
0.01). Furthermore, the frequency of J point elevation \selectlanguage{english}[?] 0.2 mV in the
3rd ICS was higher in patients with IVF (26\%) than controls (3\%) (OR,
11.7; 95\% CI, 3.0--46.6; \emph{P} \textless{} 0.01). J point elevation
was present only in the 3rd ICS but not in the 4th ICS in 30\% of
patients with IVF and only in 7\% of controls (\emph{P} \textless{}
0.01). The frequency of inferolateral early repolarization and the other
ECG parameters were not different between the two groups.

\textbf{Comparisons between patients with IVF and those with BrS}

The clinical and ECG characteristics of 35 patients with IVF and 15
patients with BrS are shown in Table 2. Among patients with IVF, J point
elevation \selectlanguage{english}[?] 0.1 mV in the 3rd ICS was present in 14 patients. VF
developed during physical efforts more often in IVF patients without J
point elevation in the 3rd ICS than BrS patients (P\textless{}0.05).
There was no difference in activity status at the onset of VF between
IVF patients with and without J point elevation in the 3rd ICS. There
was no difference in other clinical characteristics and ECG findings
among three groups. The frequency of inferolateral ER was similar in
three groups. There was no difference in ECG findings except for Brugada
ECG in three groups.

\textbf{Clinical outcome}

The follow-up period after ICD implantation in the IVF group with J
point elevations in the 3rd ICS, the IVF group without, and the BrS
group was 118 +- 80 months, 109 +- 61 months, and 105 +- 70 months,
respectively. Two patients in BrS group were treated with bepridil. None
of patients with IVF received antiarrhythmic drugs.

During a follow up of 110 +- 69 months, the recurrence of VF was observed
in 5 of 14 IVF patients with J point elevation in the 3rd ICS (36\%), 2
of 21 IVF patients without J point elevation in the 3rd ICS (10\%), and
6 of 15 BrS patients (40\%). The frequency of VF recurrences was higher
in IVF patients with J point elevation in the 3rd ICS and Brugada
syndrome than IVF patients without J point elevation in the 3rd ICS
(P\textless{}0.05 for both). Electrical storm was observed in one of IVF
patient (7\%) with J point elevation in the 3rd ICS, none of IVF patient
without J point elevation in the 3rd ICS, and one of BrS patient (7\%).
None of the patients died during the follow-up.

\textbf{Discussion}

We directly compared ECG findings in the high ICS in IVF patients and
generally healthy individuals. The frequency of J point elevation in
high precordial leads was higher in patients with IVF than healthy
controls, although the frequency of J point elevation in standard
precordial leads was similar between two groups. Furthermore, J point
elevation in high precordial leads was associated with risk of VF
recurrences in patients with IVF.

\textbf{Frequency of J point elevation in high intercostal spaces}

There have been several reports on ECGs in high right precordial leads
in healthy individuals. In a study from South Korea including 225
healthy men, J point elevation \textgreater{} 0.2mV was observed in the
4th ICS in 0\% of subjects, and was observed in the 3rd ICS in
1.3\%.\textsuperscript{11} In a report from Turkey including 504 healthy
men, J point elevation \selectlanguage{english}[?] 0.2 mV were observed in the 4th ICS in 3\% of
subjects, whereas the prevalence increased to 5\% in the 3rd
ICS\textsuperscript{12}. In a report from Japan including 206 men, the
prevalence of J point elevation \selectlanguage{english}[?] 0.2 mV increased from 1.5\% in the 4th
ICS to 5.8\% in the 3rd ICS\textsuperscript{13}. In this study, the
prevalence of J point elevation \selectlanguage{english}[?] 0.2 mV in healthy control group (1.9\%
of in the 4th ICS and 2.9\% in the 3rd ICS) was similar to those in the
previous studies.

The frequency of J point elevation in the 3rd ICS \selectlanguage{english}[?] 0.1 mV was higher in
patients with IVF than healthy controls, and the difference became more
pronounced when limited to J point elevation \selectlanguage{english}[?] 0.2mV. There have been
few previous studies investigating ECGs in the high intercostal space in
IVF patients. In a study by Kamakura \emph{et
al.\textsuperscript{14}}including 32 patients with early repolarization
syndrome, J point elevation \selectlanguage{english}[?] 0.1mV was observed in the 4th ICS in 8
patients (25\%) and was observed in the high ICS in 13 patients (41\%).
The frequency of J point elevation in right precordial leads seems
similar between the previous study and this study, although there was
only 17\% of patients with early repolarization syndrome in this study.

\textbf{Characteristics of IVF patients with J point elevation in the
3rd intercostal space}

There is a strong male dominance in IVF, early repolarization syndrome,
and BrS.\textsuperscript{15, 16} Similar to these diseases characterized
by risk of VF unassociated with structural heart diseases, majority of
patients with J point elevation in the 3rd ICS were men (93\%). In this
study, VF occurred less frequently during exercise in IVF patients with
J point elevation in the 3rd ICS than those without J point elevation in
right ICS, suggesting that increased vagal tone is associated with risk
of VF in patients with J point elevation in the 3rd ICS. In BrS, VF is
associated increased vagal tone and often develops at rest and during
sleep.\textsuperscript{17, 18} The characteristic J point and ST-segment
elevation is often pronounced in the 3rd and 2nd ICS in BrS. Although
Type I Brugada ECG was not observed in patients with J point elevation
in the 3rd ICS at rest and during sodium channel blocker test, IVF with
J point elevation in the 3rd ICS and BrS share clinical and
electrophysiological characteristics, suggesting the presence of common
arrhythmogenic substrate between two disorders.

Kamakura \emph{et al.\textsuperscript{16}} reported that the frequency
of VF recurrences is higher in ERS patients with J point elevation in
standard and/or high right ICS (58\%) than those without J point
elevation in right ICS (11\%). In this study, the frequency of VF
recurrences was also higher in IVF patients with J point elevation in
high right ICS (36\%) than those without J point elevation in right ICS
(11\%). Taken together, J point elevation in 3rd ICS may be an
electrographic risk factor for VF recurrence in patients with VF
unassociated with structural heart diseases.

\textbf{Study Limitations}

This study had some limitations. This was a retrospective analysis at a
single center. The small number of IVF patients may have influenced our
interpretation of the results, despite the number being comparable to
other previous studies.\textsuperscript{14, 16} There is a need for a
large prospective study.

\textbf{Conclusion}

Our study found that the prevalence of J point elevation in the 3rd ICS
was high in patients with IVF. J point elevation in the 3rd ICS may be a
risk factor for VF recurrence in patients with IVF. Electrocardiogram
recordings in high ICS may be useful to identify risk of sudden death.

\textbf{References}

1. Huikuri HV, Castellanos A and Myerburg RJ. Sudden death due to
cardiac arrhythmias. \emph{The New England journal of medicine} .
2001;345:1473-82.

2. Conte G, Caputo ML, Regoli F, Marcon S, Klersy C, Adjibodou B, Del
Bufalo A, Moccetti T and Auricchio A. True idiopathic ventricular
fibrillation in out-of-hospital cardiac arrest survivors in the Swiss
Canton Ticino: prevalence, clinical features, and long-term
follow-up.\emph{Europace : European pacing, arrhythmias, and cardiac
electrophysiology : journal of the working groups on cardiac pacing,
arrhythmias, and cardiac cellular electrophysiology of the European
Society of Cardiology} . 2017;19:259-266.

3. Waldmann V, Bougouin W, Karam N, Dumas F, Sharifzadehgan A,
Gandjbakhch E, Algalarrondo V, Narayanan K, Zhao A, Amet D, Jost D, Geri
G, Lamhaut L, Beganton F, Ludes B, Bruneval P, Plu I, Hidden-Lucet F,
Albuisson J, Lavergne T, Piot O, Alonso C, Leenhardt A, Lellouche N,
Extramiana F, Cariou A, Jouven X and Marijon E. Characteristics and
clinical assessment of unexplained sudden cardiac arrest in the
real-world setting: focus on idiopathic ventricular
fibrillation.\emph{European heart journal} . 2018;39:1981-1987.

4. Haissaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L,
Pasquie JL, Nogami A, Babuty D, Yli-Mayry S, De Chillou C, Scanu P, Mabo
P, Matsuo S, Probst V, Le Scouarnec S, Defaye P, Schlaepfer J, Rostock
T, Lacroix D, Lamaison D, Lavergne T, Aizawa Y, Englund A, Anselme F,
O'Neill M, Hocini M, Lim KT, Knecht S, Veenhuyzen GD, Bordachar P,
Chauvin M, Jais P, Coureau G, Chene G, Klein GJ and Clementy J. Sudden
cardiac arrest associated with early repolarization. \emph{The New
England journal of medicine} . 2008;358:2016-23.

5. Rosso R, Kogan E, Belhassen B, Rozovski U, Scheinman MM, Zeltser D,
Halkin A, Steinvil A, Heller K, Glikson M, Katz A and Viskin S. J-point
elevation in survivors of primary ventricular fibrillation and matched
control subjects: incidence and clinical significance. \emph{Journal of
the American College of Cardiology} . 2008;52:1231-8.

6. Tikkanen JT, Anttonen O, Junttila MJ, Aro AL, Kerola T, Rissanen HA,
Reunanen A and Huikuri HV. Long-term outcome associated with early
repolarization on electrocardiography. \emph{The New England journal of
medicine} . 2009;361:2529-37.

7. Antzelevitch C and Yan GX. J wave syndromes. \emph{Heart rhythm} .
2010;7:549-58.

8. Brugada P and Brugada J. Right bundle branch block, persistent ST
segment elevation and sudden cardiac death: a distinct clinical and
electrocardiographic syndrome. A multicenter report. \emph{Journal of
the American College of Cardiology} . 1992;20:1391-6.

9. Savastano S, Rordorf R, Vicentini A, Petracci B, Taravelli E,
Castelletti S, D'Errico A, Torchio M, Dossena C, Novara P, Dagradi F,
Landolina M, Spazzolini C, Crotti L and Schwartz PJ. A comprehensive
electrocardiographic, molecular, and echocardiographic study of Brugada
syndrome: validation of the 2013 diagnostic criteria. \emph{Heart
rhythm} . 2014;11:1176-83.

10. Priori SG, Blomstrom-Lundqvist C, Mazzanti A, Blom N, Borggrefe M,
Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P,
Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekval TM,
Spaulding C and Van Veldhuisen DJ. 2015 ESC Guidelines for the
management of patients with ventricular arrhythmias and the prevention
of sudden cardiac death: The Task Force for the Management of Patients
with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death
of the European Society of Cardiology (ESC). Endorsed by: Association
for European Paediatric and Congenital Cardiology (AEPC). \emph{European
heart journal} . 2015;36:2793-2867.

11. Shin SC, Ryu HM, Lee JH, Chang BJ, Shin JK, Kim HS, Heo JH, Yang DH,
Park HS, Cho Y, Chae SC, Jun JE and Park WH. Prevalence of the
Brugada-type ECG recorded from higher intercostal spaces in healthy
Korean males. \emph{Circ J} . 2005;69:1064-7.

12. Hunuk B, Kepez A and Erdogan O. Prevalence of Brugada-type
electrocardiogram pattern by recording right precordial leads at higher
intercostal spaces. \emph{Europace : European pacing, arrhythmias, and
cardiac electrophysiology : journal of the working groups on cardiac
pacing, arrhythmias, and cardiac cellular electrophysiology of the
European Society of Cardiology} . 2013;15:590-4.

13. Hisamatsu K, Morita H, Fukushima Kusano K, Takenaka S, Nagase S,
Nakamura K, Emori T and Ohe T. Evaluation of the usefulness of recording
the ECG in the 3rd intercostal space and prevalence of Brugada-type ECG
in accordance with recently established electrocardiographic
criteria.\emph{Circ J} . 2004;68:135-8.

14. Kamakura T, Wada M, Nakajima I, Ishibashi K, Miyamoto K, Okamura H,
Noda T, Aiba T, Takaki H, Yasuda S, Ogawa H, Shimizu W, Makiyama T,
Kimura T, Kamakura S and Kusano K. Significance of electrocardiogram
recording in high intercostal spaces in patients with early
repolarization syndrome. \emph{European heart journal} . 2016;37:630-7.

15. Benito B, Sarkozy A, Mont L, Henkens S, Berruezo A, Tamborero D,
Arzamendi D, Berne P, Brugada R, Brugada P and Brugada J. Gender
differences in clinical manifestations of Brugada syndrome.\emph{Journal
of the American College of Cardiology} . 2008;52:1567-73.

16. Kamakura T, Kawata H, Nakajima I, Yamada Y, Miyamoto K, Okamura H,
Noda T, Satomi K, Aiba T, Takaki H, Aihara N, Kamakura S, Kimura T and
Shimizu W. Significance of non-type 1 anterior early repolarization in
patients with inferolateral early repolarization syndrome. \emph{Journal
of the American College of Cardiology} . 2013;62:1610-8.

17. Matsuo K, Kurita T, Inagaki M, Kakishita M, Aihara N, Shimizu W,
Taguchi A, Suyama K, Kamakura S and Shimomura K. The circadian pattern
of the development of ventricular fibrillation in patients with Brugada
syndrome. \emph{European heart journal} . 1999;20:465-70.

18. Mizumaki K, Fujiki A, Tsuneda T, Sakabe M, Nishida K, Sugao M and
Inoue H. Vagal activity modulates spontaneous augmentation of ST
elevation in the daily life of patients with Brugada
syndrome.\emph{Journal of cardiovascular electrophysiology} .
2004;15:667-73.

Figure legends

Figure 1

J point elevation in the right precordial lead was defined as
upward/downward notching or downward slurring with an amplitude \selectlanguage{english}[?] 0.1 mV
at the end of QRS to early ST segment in any of the right precordial
leads (V1 and V2) in the 4th or 3rd ICS. Arrows indicate J point
elevation in the 3rd intercostal space in patients with IVF.

Figure 2

Kaplan-Meier analysis of freedom from recurrent VF during follow-up. The
IVF group with J point elevation in the 3rd ICS and the BrS group both
had significantly higher recurrences of VF compared with the IVF group
without J point elevation in the 3rd ICS.

\textbf{Hosted file}

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\textbf{Hosted file}

\verb`J point elevation JCE table.docx`  available at \url{https://authorea.com/users/345878/articles/471968-j-point-elevation-in-high-precordial-leads-associated-with-risk-of-ventricular-fibrillation}

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