Association of fragmented QRS with left atrial scarring in patients with persistent atrial fibrillation undergoing radiofrequency catheter ablation

Canpolat, Uğur; Mohanty, Sanghamitra; Trivedi, Chintan; Chen, Qiong; Ayhan, Hüseyin; Gianni, Carola; Rocca, Domenico G. Della; MacDonald, Bryan; Burkhardt, J. David; Bassiouny, Mohammed; Gallinghouse, G. Joseph; Al‐Ahmad, Amin; Horton, Rodney; Biase, Luigi Di

doi:10.1016/j.hrthm.2019.09.010

Cited by 10 publications

(11 citation statements)

References 34 publications

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“…Almost nine patients out of ten were observed with fQRS in our cohortthe highest prevalence reported to date. In previous studies on patients with established structural heart disease or AF, the prevalence of fQRS has ranged between 30 and 50% and the rates have been similar among patients with CKD stage 3-5 [8,9,[19][20][21]. As with LAE, the high fQRS rate may partly be explained by the high rate of cardiovascular comorbidities in our study population since fQRS has been associated with diabetes, CAD and, vascular calcification in prior reports [8,18,22].…”

Section: Discussionsupporting

confidence: 57%

“…As with LAE, the high fQRS rate may partly be explained by the high rate of cardiovascular comorbidities in our study population since fQRS has been associated with diabetes, CAD and, vascular calcification in prior reports [8,18,22]. In recent studies, fQRS has been linked to the incidence of new-onset AF in patients with established heart disease, as well as to increased AF recurrence after cardioversion or catheter ablation [8,9,19,23,24]. It is unclear why no association between AF and fQRS was observed among patients with severe CKD in this study.…”

Section: Discussionmentioning

confidence: 74%

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Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

Hellman

Hakamäki

Lankinen

et al. 2020

BMC Cardiovasc Disord

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Background The prevalence of left atrial enlargement (LAE) and fragmented QRS (fQRS) diagnosed using ECG criteria in patients with severe chronic kidney disease (CKD) is unknown. Furthermore, there is limited data on predicting new-onset atrial fibrillation (AF) with LAE or fQRS in this patient group. Methods We enrolled 165 consecutive non-dialysis patients with CKD stage 4–5 without prior AF diagnosis between 2013 and 2017 in a prospective follow-up cohort study. LAE was defined as total P-wave duration ≥120 ms in lead II ± > 1 biphasic P-waves in leads II, III or aVF; or duration of terminal negative portion of P-wave > 40 ms or depth of terminal negative portion of P-wave > 1 mm in lead V1 from a baseline ECG, respectively. fQRS was defined as the presence of a notched R or S wave or the presence of ≥1 additional R waves (R’) or; in the presence of a wide QRS complex (> 120 ms), > 2 notches in R or S waves in two contiguous leads corresponding to a myocardial region, respectively. Results Mean age of the patients was 59 (SD 14) years, 56/165 (33.9%) were female and the mean estimated glomerular filtration rate was 12.8 ml/min/1.73m2. Altogether 29/165 (17.6%) patients were observed with new-onset AF within median follow-up of 3 [IQR 3, range 2–6] years. At baseline, 137/165 (83.0%) and 144/165 (87.3%) patients were observed with LAE and fQRS, respectively. Furthermore, LAE and fQRS co-existed in 121/165 (73.3%) patients. Neither findings were associated with the risk of new-onset AF within follow-up. Conclusion The prevalence of LAE and fQRS at baseline in this study on CKD stage 4–5 patients not on dialysis was very high. However, LAE or fQRS failed to predict occurrence of new-onset AF in these patients.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 74%

Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

Hellman

Hakamäki

Lankinen

et al. 2020

BMC Cardiovasc Disord

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“…Temiz et al showed that fQRS morphology in ECG was an independent predictor of AF development in patients without structural heart disease 11 . Canpolat et al also demonstrated that fQRS morphology is significantly related to left atrial scar in patients with permanent AF 12 . Another study conducted by Eren et al revealed that the presence of fQRS morphology may be associated with AF recurrence following electrical cardioversion 13 .…”

Section: Discussionmentioning

confidence: 93%

“…Atrium-related markers such as P wave duration (P) and P dispersion (Pd) were used while investigating ECG markers that could predict the development of AF 9 . However, in recent studies, it was reported that fragmented QRS (fQRS) morphology, which is accepted as an indicator of myocardial fibrosis, heterogeneous depolarization and chronic ischemia, may be a predictor of AF [10][11][12][13][14] . To the best of our knowledge, there is a lack of literature on the relationship of atrial and ventricular ECG markers and fQRS with the risk of developing AF in HD patients.…”

Section: Introductionmentioning

confidence: 99%

Association of Fragmented QRS Morphology With Risk of Atrial Fibrillation in Hemodialysis Patients

Aksu

2020

Dicle Tıp Dergisi

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Objective: Atrial fibrillation (AF) is the most common form of arrhythmia in hemodialysis (HD) patients. Fragmented QRS (fQRS) morphology has been proposed as an ECG marker to predict the risk of paroxysmal AF in various conditions. In this study, we aimed to investigate the association between risk of AF development and P dispersion (Pd) and fQRS morphology in HD patients.Methods: After analyzing the 24-hour Holter recordings of the patients, they were divided into 3 groups as without atrial runs (WAR), short atrial runs (SAR), and silent paroxysmal atrial fibrillation episode (SPAFE). In ECGs taken before HD, the presence of fQRS morphology was investigated, and Pd was measured.Results: As a result of the analysis of the 24-hour Holter ECG recordings, it was determined that 12 of the 74 patients had SAR, while 6 had SPAFE. The duration of hemodialysis was significantly longer in the SPAFE groups than the WAR group (p=0.026). It was found that fQRS morphology could be an independent predictor of SAR (odds ratio=0.056; 95% CI, 0.006-0.548; p=0.013). The incidence of fQRS morphology was significantly higher in the SPAFE group than the WAR group (p=0.002). However, this significance did not continue in the multivariate analysis. Pd was similar between the groups. Conclusion:This retrospective study is the first study that investigated the association of fQRS morphology with SAR and SPAFE in HD patients, and it showed that fQRS morphology may be useful in distinguishing HD patients with a high AF risk.

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“…However, the association of these changes with the disease severity has not been investigated yet [3]. In human medicine, notching of the QRS complex has been studied in various cardiovascular diseases being associated with worse prognosis [4][5][6][7][8][9][10]. It was suggested that the alteration in QRS morphology is related to regional myocardial scar, leading to a conduction delay or a fragmentation of QRS complexes [11,12].…”

Section: Introductionmentioning

confidence: 99%

Retrospective evaluation of notched and fragmented QRS complex in dogs with naturally occurring myxomatous mitral valve disease

Baisan

Turcu

Condurachi

et al. 2021

Veterinary Quarterly

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Background: Myxomatous mitral valve disease (MMVD) is the most common cardiac disease in dogs. The association of QRS notching (nQRS) or fragmentation (fQRS) with disease severity is currently unknown.Objective: To assess the prevalence of nQRS and fQRS in dogs with MMVD and its severity according to ACVIM classification and to compare the results with a group of healthy dogs. Methods:This retrospective cross-sectional study included 34 healthy control dogs and 155 dogs with spontaneous MMVD (42% of dogs in class B1, 23% in class B2 and 35% in class C). fQRS was defined as nQRS complexes in two contiguous leads in the frontal plane (leads I and aVL) and (II, III or aVF). A one-way ANOVA with Bonferroni posthoc test was used to assess the differences in continuous data between control and MMVD groups.Results: Of the MMVD group, 58% showed nQRS in at least one lead and 27% presented fQRS. There was no difference between the number of leads with a nQRS and disease severity (p=0.75) nor did the number of leads with a nQRS correlate with left atrial size (r=-0.48; p=0.5). The number of dogs with fQRS did not differ among classes of MMVD (p=0.21). nQRS and fQRS were more prevalent in dogs with MMVD compared to control dogs (p<0.01).Conclusions: This study did not identify any relationship between the number of leads with a nQRS and disease severity. However, dogs with MMVD had a higher prevalence of nQRS and fQRS compared to control group.

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Association of fragmented QRS with left atrial scarring in patients with persistent atrial fibrillation undergoing radiofrequency catheter ablation

Cited by 10 publications

References 34 publications

Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

Association of Fragmented QRS Morphology With Risk of Atrial Fibrillation in Hemodialysis Patients

Retrospective evaluation of notched and fragmented QRS complex in dogs with naturally occurring myxomatous mitral valve disease

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