Brugada syndrome associated with J waves in multiple leads and “pseudo-epsilon” wiggle waves in lateral leads: Possible conduction delay in J-wave syndrome

We present a case of Brugada syndrome associated with augmentation of multiple J waves and the presence of “pseudo-epsilon” wiggle waves in the lateral leads. Just after ventricular fibrillation (VF), J waves were prominent in leads V1 through V4 and in the inferior leads. Moreover, pseudo-epsilon wiggle waves were recorded at the terminal portion of the QRS-complexes in leads V5 and V6. Oral administration of quinidine eliminated the epsilon-like waves and J waves, thus completely suppressing VF. In this case, both the pseudo-epsilon wiggle waves in the lateral leads and the J waves were thought to be associated with VF. In this case report, we discuss the etiology of J-wave syndrome from the perspective of the appearance of epsilon-like delayed waves.