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J Wave (Osborn Wave)

J wave, Osborn wave

Normal ECG Curve

• Action Potential
• Differs slightly between the endocardium and epicardium
• Due to differences in ion channel properties
• Phase 0 and 1 generate the QRS complex on the ECG

Causes of J Wave (Osborn Wave)

• Hypothermia is the most common cause of the Osborn wave
• The Osborn wave appears in hypothermia < 32°C
• The J wave is often referred to as the Osborn wave
• Benign Early Repolarization
• Hypercalcemia
• Intracranial Hypertension
• Normal Variant
• The J wave is a normal variant in young athletes, without structural heart disease.
• The J wave is a risk factor for idiopathic ventricular fibrillation
• The relationship of the J wave to ventricular fibrillation was described by the French cardiologist: d’Haïssaguerre
• Ventricular fibrillation occurring with the J wave is known as Le syndrome d’Haïssaguerre
• Some Medications

Hypothermia

• Osborn wave at the end of QRS
• in two adjacent leads

Benign Early Repolarization

• Osborn wave
  resembles a fish hook

Hypercalcemia

• Osborn wave as a
  notch (rare variant)

ECG and Dynamics of the Osborn Wave in Hypothermia

Hypothermia (32°C)

• Note the amplitude and width of the Osborn wave
• which will decrease with rewarming
• QT interval is also prolonged in hypothermia
• Corrected QT interval: 578ms

Hypothermia (34°C)

• Corrected QT interval: 504ms

Hypothermia (35°C)

• Corrected QT interval: 506ms

Hypothermia (36°C)

• The Osborn wave at 36°C has almost disappeared
• Corrected QT interval: 462ms

J Wave and Hypothermia (29°C)

• Osborn waves (I, II, V2-5)
• Atrial fibrillation
• Heart rate approximately 40/min.
• During hypothermia, atrial fibrillation with slow conduction to the ventricles may occur

J Wave and Benign Early Repolarization

• Osborn waves (V4 - V6)
• Benign Early Repolarization
• Osborn waves create a notch at the terminal part of the QRS complex (less common variant of Osborn waves)
• Osborn waves and concave ST segment resemble a fish hook
• Fish hook is characteristic of benign early repolarization
• Benign early repolarization is considered a normal variant and occurs in young individuals