Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Pacing Clin Electrophysiol. 2021 Apr;44(4):657-666. doi: 10.1111/pace.14203. Epub 2021 Mar 9.
J-waves and fragmented QRS (fQRS) on surface ECGs have been associated with the occurrence of ventricular tachyarrhythmias. Whether these non-invasive parameters can also predict ventricular tachycardia (VT) recurrence after radiofrequency catheter ablation (RFCA) is unknown. Of interest, patients with a wide QRS-complex have been excluded from clinical studies on J-waves, although a J-wave like pattern has been described for wide QRS.
We retrospectively included 168 patients (67 ± 10 years; 146 men) who underwent RFCA of post-infarct VT. J-wave pattern were defined as J-point elevation ≥ 0.1 mV in at least two leads irrespective of QRS width. fQRS was defined as various RSR` pattern in patients with narrow QRS and more than two R wave in those with wide QRS. The primary endpoint was VT recurrence after RFCA up to 24 months.
J-wave pattern and fQRS were present in 27 and 28 patients, respectively. Overlap of J-wave pattern and fQRS was observed in nine. During a median follow-up of 20 (interquartile range 9-24) months, 46 (27%) patients had VT recurrence. Kaplan-Meier curves revealed that both J-wave pattern and fQRS were associated with VT recurrence. Multivariate Cox regression analysis demonstrated that the presence of J-wave pattern (hazard ratio [HR] 2.84; 95% confidence interval [CI] 1.45-5.58; P = .002) and greater number of induced VT (HR 1.29; 95% CI 1.15-1.45; P < .001) were the independent predictors of VT recurrence.
A J-wave pattern-but not fQRS-is independently associated with an increased risk of post-infarct VT recurrence after RFCA irrespective of QRS width. This simple non-invasive parameter may identify patients who require additional treatment.
体表心电图上的 J 波和碎裂 QRS（fQRS）与室性心动过速/颤动（VT）的发生有关。这些非侵入性参数是否也能预测射频导管消融（RFCA）后的 VT 复发尚不清楚。有趣的是，尽管已经描述了宽 QRS 中的 J 波样模式，但 J 波样形态的患者已被排除在 J 波的临床研究之外。
我们回顾性纳入了 168 名（67±10 岁；146 名男性）接受心肌梗死后 VT 的 RFCA 治疗的患者。J 波形态定义为至少两个导联 J 点抬高≥0.1 mV，无论 QRS 宽度如何。fQRS 在 QRS 较窄的患者中定义为各种 RSR`形态，而在 QRS 较宽的患者中定义为有超过两个 R 波。主要终点是 RFCA 后 24 个月内的 VT 复发。
27 例患者存在 J 波形态，28 例患者存在 fQRS。9 例患者 J 波形态和 fQRS 重叠。在中位数为 20（四分位距 9-24）个月的随访期间，46 例（27%）患者发生 VT 复发。Kaplan-Meier 曲线显示 J 波形态和 fQRS 均与 VT 复发相关。多变量 Cox 回归分析表明，J 波形态的存在（风险比 [HR] 2.84；95%置信区间 [CI] 1.45-5.58；P=0.002）和更多的诱发 VT（HR 1.29；95% CI 1.15-1.45；P<0.001）是 VT 复发的独立预测因子。
J 波形态（但不是 fQRS）与 RFCA 后心肌梗死后 VT 复发的风险增加独立相关，无论 QRS 宽度如何。这种简单的非侵入性参数可能可以识别需要额外治疗的患者。
