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Abstract
The J wave, also referred to as an Osborn wave, is a deflection immediately following
the QRS complex of the surface ECG. When partially buried in the R wave, the J wave
appears as J-point elevation or ST-segment elevation. Several lines of evidence have
suggested that arrhythmias associated with an early repolarization pattern in the
inferior or mid to lateral precordial leads, Brugada syndrome, or arrhythmias associated
with hypothermia and the acute phase of ST-segment elevation myocardial infarction
are mechanistically linked to abnormalities in the manifestation of the transient
outward current (I(to))-mediated J wave. Although Brugada syndrome and early repolarization
syndrome differ with respect to the magnitude and lead location of abnormal J-wave
manifestation, they can be considered to represent a continuous spectrum of phenotypic
expression that we propose be termed J-wave syndromes. This review summarizes our
current state of knowledge concerning J-wave syndromes, bridging basic and clinical
aspects. We propose to divide early repolarization syndrome into three subtypes: type
1, which displays an early repolarization pattern predominantly in the lateral precordial
leads, is prevalent among healthy male athletes and is rarely seen in ventricular
fibrillation survivors; type 2, which displays an early repolarization pattern predominantly
in the inferior or inferolateral leads, is associated with a higher level of risk;
and type 3, which displays an early repolarization pattern globally in the inferior,
lateral, and right precordial leads, is associated with the highest level of risk
for development of malignant arrhythmias and is often associated with ventricular
fibrillation storms.
Copyright 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.