Key result
Inferior or lateral J-waves linked to ~278% higher odds of HUT-induced reflex syncope.
Why the study?
Is the presence of J-wave associated with a higher rate of positive head-up tilt test in patients with syncope?
Observational (n=259)
No
Is the presence of J-wave associated with a higher rate of positive head-up tilt test in patients with syncope?
The presence of a J-wave in inferior or lateral leads is highly prevalent in patients with syncope and is strongly associated with HUT-induced neurally mediated reflex syncope.
Answers are grounded in this paper and cite their sources.
J-wave may aid syncope evaluation; leaves open prospective validation before changing tilt-test protocols or risk models.
BACKGROUND: Syncope is a common occurrence. The presence of J-wave, also known as early repolarization, on electrocardiogram is often seen in the general population, but the relationship between syncope and J-wave is unclear. METHODS AND RESULTS: After excluding 67 patients with structural heart disease from 326 with syncope, we classified 259 patients according to the presence or absence of J-wave (≥1 mm) in at least 2 inferior or lateral leads. Head-up tilt test (HUT) was performed for 30 min. If no syncope or presyncope occurred, HUT was repeated after drug loading. Before tilt, 97/259 (37%) had J-wave (57 male, 47.6±22.5 years) and 162 patients had no remarkable change (89 male, 51.1±21.2 years). HUT-positive rate was higher in patients with J-wave, compared with patients without (P<0.0001). The combination of J-wave and descending/horizontal ST segment in the inferior leads was more strongly associated with positive HUT than J-wave with ascending ST segment (odds ratio, 3.23). CONCLUSIONS: Prevalence of J-wave in the inferior or lateral leads was high in patients with syncope and was associated with HUT-induced neurally mediated reflex syncope (NMRS). Furthermore, the combination of J-wave and descending/horizontal ST segment in the inferior leads could be associated with a much higher risk of NMRS.
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Chiba et al. (2015) conducted an observational in Syncope (n=259). Presence of J-wave vs. Absence of J-wave was evaluated on Positive head-up tilt test (HUT) indicating neurally mediated reflex syncope (OR 3.78, 95% CI 2.20-6.62, p=<0.001). The presence of a J-wave in the inferior or lateral leads was associated with a higher rate of HUT-induced neurally mediated reflex syncope compared to patients without a J-wave.
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