J Wave in Brugada Syndrome

J wave in inforo/ateral leads is more frequently recognized in patients (pts) with idiopahtic ventricular fibrillation (IVF) than in control subjects, and a new concept of early repolarization syndrome or J wave syndrome has been proposed. Brugada syndrome is characterized by ST-segment elevation in the right precordial leads. In our cohort of 49 Brugada pts with documented VF (46 males, 46±13years), J wave was recorded persistently in 15 pts (30.6%, P-group), intermittently in 16 pts (32.6%, I-group), and never recorded in 18 pts (36.7%, N-group). During follow-up period (7.7 ±3.8 years), VF recurred in all 15 pts with P-group (100%), and less in 12 pts with I-group (75%, p=0.11, log rank test) and in 8 pts with N-group (44%, p=0.0001, log rank test). These data suggest higher prevalence of J wave (31/49, 63.2%) in Brugada synforme with documented VF and a significant association between J wave and VF in Brugada syndrome. J wave amplitude in the infero/lateral leads was attenuated with sodium channel blocker in most Brugada pts, whereas ST-segment elevation was augmeted or coved type (type 1) ECG was unmasked in the right precordial leads, indicating the differential mechanism between the ST-segment elevation in the right precordial leads and J wave in the infero/lateral leads in Brugada syndrome.