The Value Of Ischemic J Wave In Different Leads For Predicting The Occurrence Of Ventricular Fibrillation (VF) For Patients With Acute ST-segment Elevation Myocardial Infarction

OBJECTIVE:To discuss the value of ischemic J wave in different leads for predicting the occurrence of ventricular fibrillation(VF)in the short term for patients with acute ST-segment elevation myocardial infarction.METHOD:Retrospective analysis was made for patients definitely diagnosed with ASTEMI in our hospital from January 2014 to January 2017,and these patients were divided into ischemic J wave group and non-ischemic J wave(without J wave)group based on whether ischemic J wave appeared on their ECGs.Basic clinical data and results of laboratory tests of these two groups were compared;The incidence of ischemic J wave in ASTEMI patients was analyzed based on ischemic J wave on ECGs;The value of ischemic J wave for predicting the occurrence of Vf in the short term for ASTEMI patients was analyzed;and Patients underwent Vf in these two groups were further divided into lower wall group,anterior wall group and lateral wall group based on their myocardial infarction sites,and the correlation of ischemic J waves in different sites with Vf were compared.RESULTS:There was no significant difference between ischemic J wave group and non ischemic J wave group in sex,age,smoking,hypertension,diabetes and hyperlipidemia(P > 0.05).The mean onset duration was(2.85±1.31 hours)for the ischemic J wavegroup and(4.05±1.11hours)for the non-ischemic J wave group,and the ischemic J wave appeared at early phase of acute myocardial infarction(P = 0.001).The incidence of Vf was higher in the ischemic J wave group than in the non-ischemic J wave group the difference between them being of statistical significance(P= 0.037).The levels of serum creatinine,blood glucose and white blood cell were higher for patients underwent Vf in the ischemic J wave group than those in the non-ischemic J wave group(P=0.006,0.012,0.008).In the ischemic J wave group,the incidence of Vf reached 6.46%(38 cases),with 23 lower wall Vf cases(15.86%),10 anterior wall Vf ases(6.02%)and 5 lateral wall Vf cases(2.09%),and of patients underwent lower wall myocardial infarction,16 cases were complicated by right ventricular infarction(15.84%),and the incidence of Af was as follows: lower wall > anterior wall > lateral wall(P =0.012,0.048,0.001);in the non-ischemic J wave group,the incidence of Vf reached 3.60%(17 cases),with 4 lower wall Vfcases(2.42%),8 anterior wall Vf cases(4.71%)and 5 lateral wall Vf cases(3.70%),and of patients underwent lower wall myocardial infarction,2 cases were complicated by right ventricular infarction(8.77%),and the incidence of Vf in anterior wall was higher than those in lower wall and lateral wall.According to the ROC curve,it is concluded that the area under different lead curves is different,the difference of Vf incidence associated with ischemic J wave in different sites was of statistical significance.CONCLUSION:1.ASTEMI patients showed ischemic J waves early,in the acute phase for most cases.2.For ASTEMI patients whose ECGs showed ischemic J waves,the incidence of Vf in them remarkably increased.3.The incidence of Vf for ischemic J waves in different infarction sites was as follows: lower wall > anterior wall > lateral wall;in case the ischemic J wave appeared in the lower wall and the right ventricle,the incidence of Vf in the short time remarkably increased.4.Ischemic J wave in different sites could serve as a warning signal for Vf andsudden death.