Intracoronary acetylcholine–induced augmentation of J waves: A case of idiopathic ventricular fibrillation Shohei Kishi, MD, Koichi Fuse, MD, PhD, Hitoshi.

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Intracoronary acetylcholine–induced augmentation of J waves: A case of idiopathic ventricular fibrillation Shohei Kishi, MD, Koichi Fuse, MD, PhD, Hitoshi Kitazawa, MD, Takao Sato, MD, PhD, Msaaki Okabe, MD, Yoshifusa Aizawa, MD, PhD HeartRhythm Case Reports Volume 4, Issue 6, Pages 247-250 (June 2018) DOI: 10.1016/j.hrcr.2018.02.014 Copyright © 2018 Heart Rhythm Society Terms and Conditions

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. HeartRhythm Case Reports 2018 4, 247-250DOI: (10.1016/j.hrcr.2018.02.014) Copyright © 2018 Heart Rhythm Society Terms and Conditions

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. HeartRhythm Case Reports 2018 4, 247-250DOI: (10.1016/j.hrcr.2018.02.014) Copyright © 2018 Heart Rhythm Society Terms and Conditions