Elsevier

The American Journal of Cardiology

Volume 163, 15 January 2022, Pages 32-37
The American Journal of Cardiology

Incidence and Implications of J waves Observed During Coronary Angiography

https://doi.org/10.1016/j.amjcard.2021.09.035Get rights and content

J waves may be observed during coronary angiography (CAG), but they have not been fully studied. We investigated the characteristics of J waves in 100 consecutive patients during CAG. The patients and their family members had no history of cardiac arrest. Approximately 60% of patients had ischemic heart disease, previous myocardial infarction, or angina pectoris, but at the time of this study, the right coronary artery was shown to be normal or patent after stenting. Electrocardiogram was serially recorded to monitor J waves and alteration of the QRS complex during CAG. In 12 patients (12%), J waves (0.249 ± 0.074 mV) newly appeared during right CAG, and in another 13 patients (13%), preexisting J waves increased from 0.155 ± 0.060 mV to 0.233 ± 0.133 mV during CAG. Left CAG induced no J waves or augmentation of J waves. Distinct alterations were observed in the QRS complex during CAG of both coronary arteries. Mechanistically, myocardial ischemia induced by contrast medium was considered to result in a local conduction delay, and when it occurred in the inferior wall, the site of the late activation of the ventricle, the conduction delay was manifested as J waves. In conclusion, J waves were confirmed to emerge or increase during angiography of the right but not the left coronary artery. Myocardial ischemia induced by contrast medium caused a local conduction delay that was manifested as J waves in the inferior wall, the site of the late activation of the ventricle.

Section snippets

Results

The patients’ clinical characteristics are listed in Table 1. The mean age was 68.3 ± 14.1 years, and 87% of participants were men. In the majority of cases, angiography was performed to evaluate previous percutaneous coronary intervention for acute myocardial infarction or angina pectoris. A total of 11 patients underwent CAG before transaortic valve replacement. Comorbidities were controlled by medication and no patient complained of chest pain or distress during CAG. Including the patients

Discussion

We investigated the incidence of CAG-induced J waves or augmentation of J waves in 100 consecutive patients who underwent CAG. The majority had undergone stenting for angina pectoris or myocardial infarction, but none had significant stenosis in the right coronary artery, including the stenting site, at the time of this study. Nonischemic heart diseases included idiopathic cardiomyopathy and valvular heart disease. In inferior leads, new J waves or augmentation of the J-wave amplitude was

Funding

None.

Disclosures

The authors have no conflicts of interest to declare.

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