Electrocardiographic J-Wave and Cardiovascular Outcomes in the General Population (from the Atherosclerosis Risk in Communities Study)

The association between the J-wave, a key component of the early repolarization pattern, and adverse cardiovascular outcomes remains unclear. Inconsistencies have stemmed from the different methods used to measure the J-wave. We examined the association between the J-wave, detected by an automated method, and adverse cardiovascular outcomes in 14,592 (mean age = 54 ± 5.8 years; 56% female; 26% black) participants from the Atherosclerosis Risk In Communities (ARIC) study. The J-wave was detected at baseline (1987-1989) and during follow-up study visits (1990-1992, 1993-1995, and 1996-1998) using a fully automated method. Sudden cardiac death (SCD), coronary heart disease (CHD) death, and cardiovascular mortality were ascertained from hospital discharge records, death certificates, and autopsy data through December 31, 2010. A total of 278 (1.9%) participants had evidence of a J-wave. Over a median follow-up of 22 years, 4,376 (30%) of the participants died. In a multivariable Cox regression analysis adjusted for demographics, cardiovascular risk factors, and potential confounders, the J-wave was not associated with an increased risk of SCD (HR = 0.74, 95%CI = 0.36, 1.50), CHD death (HR = 0.72, 95%CI = 0.40, 1.32), or cardiovascular mortality (HR = 1.16, 95%CI = 0.87, 1.56). An interaction was detected for cardiovascular mortality by sex with males (HR = 1.54, 95%CI = 1.09, 2.19) having a stronger association than females (HR = 0.74, 95%CI = 0.43, 1.25) (P-interaction = 0.030). In conclusion, our findings suggest that the J-wave is a benign entity that is not associated with an increased risk for sudden cardiac arrest among middle aged adults in the United States.