Naruse Yoshihisa, Nogami Akihiko, Shinoda Yasutoshi, Hanaki Yuichi, Shirai Yasuhiro, Kowase Shinya, Kurosaki Kenji, Machino Takeshi, Kuroki Kenji, Yamasaki Hiro, Igarashi Miyako, Sekiguchi Yukio, Aonuma Kazutaka
Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan.
J Cardiovasc Electrophysiol. 2016 Dec;27(12):1448-1453. doi: 10.1111/jce.13096. Epub 2016 Oct 6.
Recent studies showed that J waves were associated with higher incidence of ventricular tachyarrhythmia (VT/VF) in patients with idiopathic ventricular fibrillation (VF) and myocardial infarction. We sought to assess the association between J waves and VT/VF in patients with nonischemic cardiomyopathy (NICM).
We retrospectively enrolled 109 patients (79 men; mean age, 60 ± 15 years) with NICM who underwent implantable cardioverter defibrillator (ICD) implantation. The primary endpoint of this study was the occurrence of appropriate device therapy due to sustained VT/VF. The J wave was electrocardiographically defined as an elevation of the terminal portion of the QRS complex of >0.1 mV in at least 2 contiguous inferior or lateral leads. Among the 109 patients, 37 (34%) experienced an episode of appropriate device therapy during a median follow-up period of 25.9 (IQR 11.5-54.3) months. Kaplan-Meier curves showed that the presence of J waves on the 12-lead ECG obtained before device implantation was associated with an increased occurrence of appropriate device therapy (P < 0.001). Multivariate Cox proportional regression analysis revealed that the presence of J waves (HR 2.95; 95% CI 1.31-6.64; P = 0.009) was an independent predictor for the occurrence of appropriate device therapy. In the subgroup analysis of the patients with dilated or hypertrophic cardiomyopathy, J wave tended to increase the occurrence of appropriate device therapy (P = 0.056 and P = 0.092, respectively).
The presence of J waves was an independent predictor for the occurrence of appropriate device therapy in patients with NICM who underwent ICD implantation.
近期研究表明，J波与特发性心室颤动（VF）和心肌梗死患者发生室性快速心律失常（VT/VF）的较高发生率相关。我们试图评估非缺血性心肌病（NICM）患者中J波与VT/VF之间的关联。
我们回顾性纳入了109例接受植入式心律转复除颤器（ICD）植入的NICM患者（79例男性；平均年龄60±15岁）。本研究的主要终点是因持续性VT/VF而进行的适当器械治疗的发生情况。J波在心电图上定义为至少2个相邻下壁或侧壁导联中QRS波群终末部分抬高>0.1 mV。在109例患者中，37例（34%）在中位随访期25.9（四分位间距11.5 - 54.3）个月期间经历了一次适当器械治疗事件。Kaplan-Meier曲线显示，在器械植入前获得的12导联心电图上存在J波与适当器械治疗的发生率增加相关（P<0.001）。多变量Cox比例回归分析显示，J波的存在（风险比2.95；95%置信区间1.31 - 6.64；P = 0.009）是适当器械治疗发生的独立预测因素。在扩张型或肥厚型心肌病患者的亚组分析中，J波倾向于增加适当器械治疗的发生率（分别为P = 0.056和P = 0.092）。
J波的存在是接受ICD植入的NICM患者发生适当器械治疗的独立预测因素。
