The Prognostic Value of J‐wave Pattern for Recurrence of Ventricular Tachycardia after Catheter Ablation in Patients with Myocardial Infarction

BACKGROUND 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. METHODS We retrospectively included 168 patients (67±10years; 146 men) who underwent RFCA of post-infarct VT. J-wave pattern were defined as J-point elevation ≥0.1mV in at least 2 leads irrespective of QRS width. fQRS was defined as various RSR` pattern in patients with narrow QRS and >2 R wave in those with wide QRS. The primary endpoint was VT recurrence after RFCA up to 24 months. RESULTS J-wave pattern and fQRS were present in 27 and 28 patients, respectively. Overlap of J-wave pattern and fQRS was observed in 9. During a median follow-up of 20 (IQR 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 (HR 2.84; 95% CI 1.45-5.58; p = 0.002) and greater number of induced VT (HR 1.29; 95% CI 1.15-1.45; p<0.001) were the independent predictors of VT recurrence. CONCLUSIONS 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. This article is protected by copyright. All rights reserved.