Idiopathic Ventricular Fibrillation with J Wave and Coronary Spasm

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Some patients with J wave syndrome have abnormalities in repolarization, and suffer from ventricular fibrillation, caused by phase 2 reentry. A 38-year-old man who had no history of chest pain or syncope was successfully resuscitated from ventricular fibrillation. A standard 12-lead ECG at rest showed J wave and ST-segment elevation in the inferior leads. No coved or saddleback type of ST-segment elevation was seen in the right precordial leads even after an infusion of pilsicainide. Late potential and T-wave alternance test were also negative. Left and right ventriculography, and cardiac MRI revealed no wall motion abnormalities in the ventricles or fat replacement in right ventricular wall. An intra-coronary acetylcholine infusion provoked coronary spasm in the left anterior descending artery. Coronary spasm coincided with ST-segment elevation in the inferior leads, but not with J wave or ventricular fibrillation. He received implantable cardioverter defibrillator and Ca blocker. We reported a case of idiopathic ventricular fibrillation who had both J waves and coronary spasm. It should be clarified whether J waves and coronary spasm can cause ventricular fibrillation independently or with some mechanistic interaction between them.