Osborn Wave (J Wave)


  • The Osborn wave (J wave) is a positive deflection at the J point (negative in aVR and V1)
  • It is usually most prominent in the precordial leads


  • Characteristically seen in hypothermia (typically T<30C), but they are not pathognomonic.
  • J waves may be seen in a number of other conditions:
    • Normal variant
    • Hypercalcaemia
    • Medications
    • Neurological insults such as intracranial hypertension, severe head injury and subarachnoid haemorrhage
    • Le syndrome d’Haïssaguerre (idiopathic VF)

Typical J Waves

Typical Osborn waves

Typical J Waves


The height of the J wave is roughly proportional to the degree of hypothermia:

Subtle J waves in mild hypothermia (temp 32.5°C)

subtle osborn waves in mild hypothermia (temp 32.5)

J waves in mild hypothermia

J waves in moderate hypothermia (temp 30°C)

J waves in moderate hypothermia (30 degrees C)

J waves in moderate hypothermia

Marked J waves in severe hypothermia (temp < 27°C)

marked osborn waves in severe hypothermia

J waves in severe hypothermia


Further Reading

Author Credits


  • Haïssaguerre M, et al. Sudden cardiac arrest associated with early repolarization. N Engl J Med. 2008 May 8;358(19):2016-23. PMID: 18463377.
  • Otero J, Lenihan DJ. The “normothermic” Osborn wave induced by severe hypercalcemia. Tex Heart Inst J. 2000;27(3):316-7. PMID: 11093425
  • Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice (6th edition), Saunders 2008.
  • Wagner, GS. Marriott’s Practical Electrocardiography (11th edition), Lippincott Williams & Wilkins 2007.
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