Fragmentation of the QRS complex in patients with acute coronary syndrome treated invasively

Abstract

A b s t r a c tBackground: Previous studies showed that the presence of fragmented QRS (f-QRS) in patients with acute coronary syndrome (ACS), who underwent complete revascularisation, is associated with worse prognosis and the possibility of arrhythmia occurrence. Aim:To assess the prognostic value of f-QRS in patients with ACS and complete revascularisation, in the context of cardiac arrhythmias. Methods:We analysed 124 consecutive patients (66.1% males; mean age 62.38 ± 11.0 years) with ACS (STEMI 49%) treated invasively. Based on electrocardiogram (ECG) record, performed during the admission to the clinic, after the complete revascularisation (TIMI = 3) and during discharging from hospital (4 th -5 th days after ACS), we classified QRS as f-QRS based on generally accepted criteria (QRS < 120 ms, which included an additional R wave [R']) or notching in the nadir of the S wave, or > 1 R' (fragmentation) in two contiguous leads, corresponding to a major coronary artery territory. 24-h Holter ECG recording was performed on the fifth day after ACS to assess the frequency of conduction disturbances and others arrhythmias.Results: There were no statistically significant differences between patients with and without f-QRS during hospitalisation. In the patients with f-QRS there were no statistically significant conduction disturbances and other arrhythmias compared to patients without f-QRS at discharge. Conclusions:In the patients with ACS, who underwent successful revascularisation (TIMI = 3), the presence of f-QRS is not correlated with a higher incidence of arrhythmias compared to patients without f-QRS in short-term follow-up.

Fragmented QRS complex frequency and location as predictor of cardiogenic shock and mortality following acute coronary syndrome

“…The Anterior f-QRS location showed significant statistical lower SBP, a higher HR, a higher incidence of cardiogenic shock (KILLIP class IV), a higher updated GRACE risk score (P = 0.033), and a higher incidence of in-hospital mortality (P = 0.004) compared to nonanterior fragmented-QRS location (Table 4). [8] acknowledged that despite numerous studies, the predictive value of f-QRS in the 12-lead ECG in patients after acute coronary syndrome is controversial. Research carried out in large groups of patients provides conflicting results, therefore, there is a need to carry out a number of meta-analysis in order to draw the right conclusions.…”

Predictive value of fragmented QRS for ventricular tachyarrhythmias in patients with acute myocardial infarction: A meta‐analysis

“…Then 241 studies were excluded based on title or abstract reading using the predefined eligibility criteria. From the remaining 12 studies that were reviewed in full text, three studies were not included because their endpoints were commingled with atrioventricular heart‐block or polymorphic ventricular extrasystoles, while another 2 were excluded because VTAs were not their observation endpoints. Unlike other studies investigating VTAs during AMI, the study by Lorgis et al investigated VTAs during long‐term follow‐up (846 ± 297 days) and was excluded for protecting our results against bias.…”

QRS-Fragmentation: Perspectives for Use in Clinical Practice

“…Сравниваемые группы (с и без fQRS) существенно различались не только по ангиографическим, но и по эхокардиографическим характеристикам, обнаруживая более низкие значения ФВ ЛЖ у пациентов с fQRS (p = 0,02) [31]. В то же время, проанализировав результаты холтеровского мониторирования ЭКГ у пациентов с полной реваскуляризацией миокарда (TIMI 3), A.M. Daszyk et al обратили внимание на отсутствие значимых различий между лицами с и без fQRS в отношении частоты регистрации основных нарушений ритма и проводимости [32].…”