Different rate-dependent responses between J waves and the notches on an epicardial local electrogram in a patient with idiopathic ventricular fibrillation

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Different rate-dependent responses between J waves and the notches on an epicardial local electrogram in a patient with idiopathic ventricular fibrillation Yosuke Kamikubo, MD, Yasuya Inden, MD, PhD, Tomoyuki Nagao, MD, PhD, Yoshifusa Aizawa, MD, PhD, Toyoaki Murohara, MD, PhD HeartRhythm Case Reports Volume 3, Issue 9, Pages 427-430 (September 2017) DOI: 10.1016/j.hrcr.2017.06.010 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 The 12-lead electrocardiogram (ECG) on admission and the epicardial electrograms. A: On admission, the standard 12-lead ECG showed J waves (as shown by arrows). Diagnostic J waves were present in leads I (0.12 mV) and III (0.13 mV). B: Epicardial electrograms were recorded in bipolar (Epi 1-2, 3-4, and 5-6) and unipolar (Uni 1, 2, 3) leads. In the unipolar leads, notches (arrowheads) are evident at the timing of the J waves on the surface ECG (arrow). The notches were augmented in the beat next to the premature ventricular stimulation when the R-R interval prolonged from 740 ms to 1180 ms. Epi = electrogram recorded by bipolar leads; RVA = right ventricular apex; Uni = electrogram recorded by unipolar leads. HeartRhythm Case Reports 2017 3, 427-430DOI: (10.1016/j.hrcr.2017.06.010) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 The changes in local epicardial electrograms during atrial pacing. In the electrograms recorded by bipolar leads (Epi 1-2, 3-4, and 5-6), tiny electrical activities are extending out from the QRS complex. As the paced cycle length shortens, the duration shortens; for example, this effect can be seen in Epi 1-2 with a shortened interval from 126 ms to 105 ms. Notches are evident at the terminal portion of the main electrical activity in the electrograms recorded by unipolar leads. The timing of the peak of the notches is identical to that of the J wave on the surface electrocardiogram. The amplitude of the notches decreased in amplitude in each lead (Uni-1 to Uni-3). Epi = electrogram recorded by bipolar leads; Uni = electrogram recorded by unipolar leads. HeartRhythm Case Reports 2017 3, 427-430DOI: (10.1016/j.hrcr.2017.06.010) Copyright © 2017 Heart Rhythm Society Terms and Conditions