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Original research
Long-term prognosis of patients with J-wave syndrome
  1. Tsukasa Kamakura1,
  2. Tetsuji Shinohara2,
  3. Kenji Yodogawa3,
  4. Nobuyuki Murakoshi4,
  5. Hiroshi Morita5,
  6. Naohiko Takahashi2,
  7. Yasuya Inden6,
  8. Wataru Shimizu3,
  9. Akihiko Nogami4,
  10. Minoru Horie7,
  11. Takeshi Aiba1,
  12. Kengo Kusano1
  1. 1 Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
  2. 2 Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
  3. 3 Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
  4. 4 Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
  5. 5 Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  6. 6 Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
  7. 7 Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan
  1. Correspondence to Dr Kengo Kusano, Department of Cardiovasclar Medicine, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan; kusanokengo{at}


Objective Limited data are currently available regarding the long-term prognosis of patients with J-wave syndrome (JWS). The aim of this study was to investigate the long-term prognosis of patients with JWS and identify predictors of the recurrence of ventricular fibrillation (VF).

Methods This was a multicentre retrospective study (seven Japanese hospitals) involving 134 patients with JWS (Brugada syndrome (BrS): 85; early repolarisation syndrome (ERS): 49) treated with an implantable cardioverter defibrillator. All patients had a history of VF. All patients with ERS underwent drug provocation testing with standard and high intercostal ECG recordings to rule out BrS. The impact of global J waves (type 1 ECG or anterior J waves and inferolateral J waves in two or more leads) on the prognosis was evaluated.

Results During the 91±66 months of the follow-up period, 52 (39%) patients (BrS: 37; ERS: 15) experienced recurrence of VF. Patients with BrS and ERS with global J waves showed a significantly higher incidence of VF recurrence than those without (BrS: log-rank, p=0.014; ERS: log-rank, p=0.0009). The presence of global J waves was a predictor of VF recurrence in patients with JWS (HR: 2.16, 95% CI 1.21 to 3.91, p=0.0095), while previously reported high-risk electrocardiographic parameters (high-amplitude J waves ≥0.2 mV and J waves associated with a horizontal or descending ST segment) were not predictive of VF recurrence.

Conclusions This multicentre long-term study showed that the presence of global J waves was associated with a higher incidence of VF recurrence in patients with JWS.

  • early repolarisation syndrome
  • brugada syndrome
  • j-wave syndrome
  • ventricular fibrillation
  • j wave

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  • Contributors TK and KK have been working on this project and have done substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. All coauthors have read and approved the submission of the manuscript.

  • Funding This work was supported by the Japan Society for the Promotion of Science (JSPS) through a Grant-in-Aid for Scientific Research (KAKENHI Grant Number JP17K09545) and the Suzuken Memorial Foundation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional Research Board of the National Cerebral and Cardiovascular Center, Suita, Japan (M22-031-5).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.