Journal of Arrhythmia (Jun 2017)

Manifestation of J wave induced by acetylcholine applied for a coronary spasm provocation test in a patient with aborted sudden cardiac death

  • Hiroyuki Kodama, MD,
  • Kazumasa Fujita, MD,
  • Shouhei Moriyama, MD,
  • Kei Irie, MD,
  • Hirotaka Noda, MD,
  • Taku Yokoyama, MD,
  • Mitsuhiro Fukata, MD, PhD,
  • Takeshi Arita, MD, PhD,
  • Keita Odashiro, MD, PhD,
  • Toru Maruyama, MD, PhD,
  • Koichi Akashi, MD, PhD

DOI
https://doi.org/10.1016/j.joa.2016.09.001
Journal volume & issue
Vol. 33, no. 3
pp. 234 – 236

Abstract

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A 51-year-old man with a resuscitation episode was referred to our hospital. Coronary angiography revealed a focal spasm overlapped with organic stenosis where a bare metal stent was implanted. Acetylcholine (ACh) provocation test did not induce chest pain. It revealed no discernible ST-T changes but unmasked a J wave at the end of the QRS complex, which was associated with short-coupled repetitive premature ventricular beats. A J wave reportedly appears immediately before the onset of ventricular fibrillation caused by vasospastic angina. However, a J wave observed newly after a coronary spasm provocation test using ACh without ST-T changes is informative when considering the mechanisms of the J wave.

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