J-Point Elevation in Survivors of Primary Ventricular Fibrillation and Matched Control Subjects
Open accessAbstract
Objectives The purpose of this study was to determine whether J-point elevation is a marker of arrhythmic risk.Background J-point elevation has been considered an innocent finding among healthy young individuals (the "early repolarization" pattern). However, this electrocardiogram (ECG) finding is increasingly being associated with idiopathic ventricular fibrillation (VF).Methods In a case-control study, the ECG of 45 patients with idiopathic VF were compared with those of 124 age- and gender-matched control subjects and with those of 121 young athletes. We measured the height of J-point and ST-segment elevation and counted the presence of slurring in the terminal portion of the R-wave.Results J-point elevation was more common among patients with idiopathic VF than among matched control subjects (42% vs. 13%, p = 0.001). This was true for J-point elevation in the inferior leads (27% vs. 8%, p = 0.006) and for J-point elevation in leads I to aVL (13% vs. 1%, p = 0.009). J-point elevation in V(4) to V(6) occurred with equal frequency among patients and matched control subjects (6.7% vs. 7.3%, p = 0.86). Male subjects had J-point elevation more often than female subjects and young athletes had J-point elevation more often than healthy adults but less often than patients with idiopathic VF. The presence of ST-segment elevation or QRS slurring did not add diagnostic value to the presence of J-point elevation.Conclusions J-point elevation is found more frequently among patients with idiopathic VF than among healthy control subjects. The frequency of J-point elevation among young athletes is intermediate (higher than among healthy adults but lower than among patients with idiopathic VF).
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Early repolarization ECG pattern (>1 mm) in the inferior/lateral leads occurs in 1% to 13% of the general population.
“Early repolarization ECG pattern (>1 mm) in the inferior/lateral leads occurs in 1% to 13% of the general population and in 15% to 70% of idiopathic VF cases (352–354).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [353]
Table 1 reports J-point elevation in healthy matched controls, including 13.0% with any elevation in any lead. But with the claimed >1 mm threshold, the figure is 8.9% in any lead, and the study’s matched controls are not a general-population sample. The cited 1%–13% range therefore does not establish the claim as qualified. (LLM, conf=0.88)
Experimental — accuracy not yet measuredEarly repolarization pattern is associated with increased risk of cardiac death in population-based studies.
“Furthermore, it has been shown in population-based studies to be associated with increased risk of cardiac death (352,353,355–357).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [353]
The Discussion reports that J-point elevation was more frequent in patients with idiopathic ventricular fibrillation than in matched healthy controls. This was a case-control study, not a population-based study of cardiac death. The Study limitations section also cautions that an incidental J-wave found during screening should not be interpreted as a marker of increased risk. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe presence of a J wave increases the risk of VF from 3.4/100,000 to 11.0/100,000.
“One study showed that the presence of a J wave increased the risk of VF from 3.4/100,000 to 11.0/100,000 (353).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [353]
The “Diagnostic power of J-point elevation” section gives the stated increase from 3.4 to 11 per 100,000, but specifically for the probability of idiopathic VF in a person aged 35–45 with a J wave. The citing sentence omits those limits and describes the figure as the risk of VF generally. The “Study limitations” section also cautions against interpreting an incidental J wave as a marker of increased risk. (LLM, conf=0.88)
Experimental — accuracy not yet measuredEarly repolarization ECG pattern (>1 mm) in the inferior/lateral leads occurs in 15% to 70% of idiopathic VF cases.
“Early repolarization ECG pattern (>1 mm) in the inferior/lateral leads occurs in 1% to 13% of the general population and in 15% to 70% of idiopathic VF cases (352–354).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [353]
The J-point ST elevation (early repolarization) pattern may become a marker of idiopathic ventricular fibrillation.
“and may thus become a marker of this life-threatening condition.”
From The Year of 2008 in Electrocardiology (2010) · cites this paper as [5]
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- Authors
- Rosso, R., Kogan, E., Belhassen, B., Rozovski, U., Scheinman, M. M., Zeltser, D., Halkin, A., Steinvil, A., Heller, K., Glikson, M., Katz, A., & Viskin, S.
- Affiliations
- Tel Aviv University (IL)
- University of California, San Francisco (US)
- Ben-Gurion University of the Negev (IL)
- Corresponding author
- Viskin, Sami
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2008-10
- Volume
- 52
- Issue
- 15
- Pages
- 1231-1238
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W71601869
- Cited by
- 566
- References
- 37
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 11 · 2023: 15 · 2022: 19 · 2021: 10 · 2020: 29 · 2019: 32 · 2018: 23 · 2017: 48 · 2016: 41 · 2015: 47 · 2014: 50 · 2013: 69 · 2012: 61
- FWCI
- 22.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- J-point elevation, idiopathic ventricular fibrillation, early repolarization, arrhythmia risk, electrocardiographic markers, youth athletes, ST-segment elevation, sex differences
- MeSH terms
- Adolescent, Adult, Aged, Electrocardiography, Female, Humans, Male, Middle Aged, Sports, Ventricular Fibrillation, Tachycardia, Ventricular
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