Intracoronary acetylcholine–induced augmentation of J waves: A case of idiopathic ventricular fibrillation

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  Figure 1. The surface electrocardiogram (ECG). A: On admission, the ECG showed atrial fibrillation. The QRS complexes were narrow without significant AT-T abnormality. Slurring was suggested in the inferior leads. On the fourth day after admission, sinus rhythm resumed. Slurring was evident in the inferior leads, II, III, and aVF. B: The J waves in leads III and aVF are bigger (smaller) when the preceding R-R interval is longer (shorter). The basic rhythm is atrial fibrillation.

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  Figure 2. Electrocardiograms during the provocation test for coronary spasm. At baseline, J waves (arrows) were present in III and aVF, which increased after intracoronary administration of acetylcholine. A dose-dependent augmentation is evident. The height of r' in V1 (white arrowheads) was increased, and the slur of the ascending limb of S in V2 (and V3) became shallower with acetylcholine (black arrowheads). However, augmentation of the J waves was negligible when acetylcholine (100 μg) was introduced into the left coronary artery, but in this case there was induced T-wave inversion in V3 through V5. The R-R interval remained almost unchanged by acetylcholine: 680 ms at baseline vs 707 ms after acetylcholine. PVC or ventricular tachycardia was not induced by acetylcholine infusion.