Early ventricular repolarization (J wave): association with other repolarization features.
Alexandru D. Corlan1, Milan B. Horacek2,
Luigi De Ambroggi 3
1University Emergency Hospital - Bucharest - Romania,
2Dept. Physiology and Biophysics, Dalhousie University, Halifax, Canada
3IRCCS Policlinico San Donato, University of Milan - San Donato Milanese - Italy,
Proc. 35th Intl. Congr. Electrocardiology, St. Petersburg, p. 22
Archived by WebCite® at
References added to this postprint, 2012-05-17.
Background The presence on ECG recordings of an early repolarization (J) wave has been
proposed [1-4] as a possible indicator of increased risk for malignant ventricular
Purpose To explore the association of the J wave with other indices based
on repolarization and the contribution of early repolarization to other
gender-related differences in indices based on the ST-T potentials, that
were previously proposed as possible markers of arrhythmogenicity in certain
subgroups and to exhibit gender differences.
Methods We studied single cardiac cycle, body surface ECG recordings in
healthy adults, 125 females and 134 males, previously recorded in the
Department of Physiology and Biophysics, Dalhousie University. An
investigator blinded to the gender and the values of any other
repolarization indices examined standard ECG printouts in each recording and
identified those with a J wave ( > 0.1mV in at least 2 leads). In each
recording we separately calculated the similarity index SI1 (the ratio of
the first eigenvalue from the principal component analysis of repolarization
potentials [5,6]), the early repolarization deviation index ERDI (the average
difference between 1 and the correlation of the instantaneous repolarization
potential distribution at each instant before the peak of T and that at the
peak of T) and the absolute correlation coefficients of the QRS integral
maps with the first and second orthogonal components of repolarization (RT1
and RT2) . Quantitative values are reported as mean ± standard deviation.
Results A J wave was identified in standard leads in 10 females (95%
confidence interval 4--14%) and 37 males (20--36%, p < 0.0001). J wave
presence was separately associated with (1) a lower ERDI in females (0.15
± 0.17 vs 0.30 ± 0.16, p<0.001) and in males (0.09 ± 0.08 vs 0.13 ± 0.10,
p < 0.05)--thus females with a J wave had an ERDI in the same range with most
males (2) a higher SI1 in females (0.78 ± 0.05 vs 0.72 ± 0.07, p < 0.01) but
not in males (0.77 ± 0.06 vs 0.77 ± 0.05, p=NS); (3) a higher RT1 (0.78 ± 0.09
vs 0.54 ± 0.21, p < 0.001) and a lower RT2 (0.54 ± 0.10 vs 0.67 ± 0.20, p < 0.05)
in females but non-significant differences in males (0.46 ± 0.24 vs 0.37 ±
p=NS) and (0.75 ± 0.19 vs 0.71 ± 0.21 p=NS).
Conclusions The presence of the early repolarization in standard ECG leads
was associated with significant differences in a variety of indices that
describe repolarization, particularly in females. This phenomenon could
explain in part the gender differences in similarity and deviation indices
where the presence of the J wave is associated with a reduction of these
differences in females.
 Haissaguere M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy
L, Pasqui JL, Nogami A, Babuty D, Yli-Mayry S, De Chillou C, Scanu
P, Mabo P, Matsuo S, Probst V, Le Scouarnec S, Defaye P, Schlaepfer J,
Rostock T, Lacroix D, Lamaison D, Lavergne T, Aizawa Y, Englund A,
Anselme F, O'Neill M, Hocini M, Lim TK, Knecht S, Veenhuyzen GD,
Bordachar P, Chauvin M, Jais P, Coureau G, Chene G, Klein GJ, Clementy
J. Sudden Cardiac Arrest Associated with Early Repolarization. N Engl
J Med 2008;358:2016-23.
 Nam GB, Kim YH. Augmentation of J Waves and Electrical Storms in
Patients with Early Repolarization. N Engl J Med 2008; 358:2078-79.
 Boineau JP. The early Repolarization variant-normal or a Marker of
Heart Disease in Certain Subjects. J Electrocardiol 2007;40:3.e11-6.
 Letsas KP, Efremidis M, Pappas LK, Gavrielatos G, Markou V,
Sideris A, Kardaras F. Early repolarization Syndrome: Is it always
benign? Int. J Cardiol 2007;114:390-9.
 De Ambroggi L, Negroni MS, Monza E, Bertoni T, Schwartz PJ.
Dispersion of ventricular repolarization in the long QT syndrome.
Am J Cardiol. 1991 Sep 1;68(6):614-20.
 AD Corlan, L De Ambroggi. New quantitative methods of ventricular
repolarization analysis in patients with left ventricular hypertrophy.
Italian Heart Journal, 2000;1:542-548.
 Susceptibility for ventricular tachycardia and the correlation between
depolarization and orthogonal components of repolarization. Corlan
AD, Horacek M, De Ambroggi L. Anadolu Kardiyol Derg. 2007 Jul;7 Suppl