Fragmented Left Sided QRS in Absence of Bundle Branch Block: Sign of Left Ventricular Aneurysm

Reddy, C.V.R.; Cheriparambill, Kuruvilla; Saul, Barry I.; Makan, Majesh; Kassotis, John; Kumar, Amarendra; Das, Mithilesh K.

doi:10.1111/j.1542-474x.2006.00094.x

Cited by 47 publications

(40 citation statements)

References 30 publications

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“…21 The study also confirmed the prior angiographic correlation of the RSRЈ pattern with MI scar. 10,11 Autopsies of patients with MI and left ventricular aneurysm have also confirmed significant myocardial necrosis, with "islands" of viable myocardial tissue interspersed in abundant fibrous tissue. The islands of chronically ischemic myocar- dium display slow activation as a result of partially depolarized and depressed action potential upstroke velocities.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 We have also demonstrated that the presence of an RSRЈ pattern, without evidence of a typical bundle-branch block (QRS Յ120 ms), is associated with ventricular aneurysm by left ventriculography. 10,11 In addition, during that study, we anecdotally found that the RSRЈ pattern was not limited to the precordial leads, and when present in inferior leads, it was often associated with inferior wall motion abnormalities. This novel observation led us to evaluate this ECG sign of a prior MI in patients referred for cardiac stress testing by nuclear perfusion analysis.…”

Section: Clinical Perspective P 2501mentioning

confidence: 99%

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Significance of a Fragmented QRS Complex Versus a Q Wave in Patients With Coronary Artery Disease

et al. 2006

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Background-Q waves on a 12-lead ECG are markers of a prior myocardial infarction (MI). However, they may regress or even disappear over time, and there is no specific ECG sign of a non-Q-wave MI. Fragmented QRS complexes (fQRSs), which include various RSRЈ patterns, without a typical bundle-branch block are markers of altered ventricular depolarization owing to a prior myocardial scar. We postulated that the presence of an fQRS might improve the ability to detect a prior MI compared with Q waves alone by ECG. Methods and Results-A cohort of 479 consecutive patients (meanϮSD age, 58.2Ϯ13.2 years; 283 males) who were referred for nuclear stress tests was studied. The fQRS included various morphologies of the QRS (Ͻ120 ms), which included an additional R wave (RЈ) or notching in the nadir of the S wave, or Ͼ1 RЈ (fragmentation) in 2 contiguous leads, corresponding to a major coronary artery territory. The Q wave was present in 71 (14.8%) patients, an fQRS was present in 191 (34.9%) patients, and an fQRS and/or a Q wave was present in 203 (42.3%) patients. Sensitivity, specificity, and the negative predictive value for myocardial scar as detected by single photon emission computed tomography analysis were 36.3%, 99.2%, and 70.8%, respectively, for the Q wave alone; 85.6%, 89%, and 92.7%, respectively, for the fQRS; and 91.4%, 89%, and 94.2%, respectively, for the Q wave and/or fQRS. Conclusions-The fQRS on a 12-lead ECG is a marker of a prior MI, defined by regional perfusion abnormalities, which has a substantially higher sensitivity and negative predictive value compared with the Q wave.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Perspective P 2501mentioning

confidence: 99%

Significance of a Fragmented QRS Complex Versus a Q Wave in Patients With Coronary Artery Disease

et al. 2006

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“…In previous studies using Gadolinium delayed enhancement on cardiac magnetic resonance imaging to determine myocardial structure, fQRS related to extensive myocardial scar (11,12). Prior studies demonstrated fQRS to be a marker of a prior MI, defined by regional perfusion abnormalities, which has a substantially higher sensitivity and negative predictive value compared to the Q wave (6,29). Regional fQRS patterns denote the presence of a greater corresponding focal regional myocardial scar on stress myocardial perfusion imaging (30).…”

Section: Discussionmentioning

confidence: 99%

Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery

Çetin¹,

Kocaman²,

Durakoğlugil³

et al. 2012

Anadolu Kardiyol Derg

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Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery Fragmente QRS izole koroner arter baypass greftleme operasyonu geçiren hastalarda postoperatif atriyal fibrilasyon gelişimini öngörebilir ABSTRACTObjective: Fragmented QRS complexes (fQRS) are defined as various RSR′ patterns in 2 contiguous leads corresponding to a major coronary artery territory. Although the reason of association between fQRS and cardiac events was documented as cardiac fibrosis, the predictive role of fQRS was not studied for postoperative atrial fibrillation (POAF) which is a frequent and serious complication in patients undergoing isolated coronary artery bypass graft (CABG) surgery. Therefore, this issue was investigated in the present study. Methods: The current study has a prospective observational design. Two hundred and seventy two eligible patients who underwent isolated CABG surgery were enrolled consecutively. The patients were divided in two groups with post-op atrial fibrillation (AF) and non-AF. The occurrence of new-onset AF following CABG and the relationship with fQRS were searched. The logistic regression analysis was used to determine independent predictors for POAF. The sensitivity and specificity of study variables in predicting POAF were calculated using a receiver-operating characteristic curve (ROC). Results: POAF occurred in 62 of 272 patients (22.8%). Patients with POAF were generally older (p<0.001) and female (p=0.006), with preexisting hypertension (p=0.008), lower hemoglobin levels (p=0.011), chronic obstructive lung disease (p=0.003), prolonged QRS time (p=0.004), and higher EUROSCORE (p<0.001) compared to non-AF patients. Patients with POAF had lower left ventricular ejection fraction (p<0.001) and high fQRS rate (p<0.001), but similar left atrial size (LA, p=NS). Interestingly, LA size was significantly enlarged in patients with fQRS (3.8±0.6 vs. 4.1±0.5 cm, p=0.002). In addition, the patients with POAF had prolonged stay in the cardiac surgery intensive-care unit (p<0.001) and extended in-hospital care (p=0.001). New-onset POAF was significantly related to the presence and number of fQRS. In the logistic regression analysis, only age (OR: 1.044, 95% CI: 1.008-1.082, p=0.016), female gender (OR: 2.347, 95% CI: 1.079-5.106, p=0.031), the presence and number of fQRS (OR: 6.020, 95% CI: 3.152-11.5 and OR: 1.522, 95% CI: 1.282-1.807, both of, p<0.001) were independent predictors of POAF. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy (DA) of presence of fQRS on pre-op electrocardiogram to predict POAF were 66%, 76%, 45%, 88% and 74%, respectively. The area under ROC was found as 0.733 (p<0.001, 95% CI: 0.657-0.810). Conclusion: In our study, we found that new-onset POAF was independently related to the presence and number of fQRS in patients undergoing CABG surgery. In addition, fQRS on pre-op surface ECG had high predictive values for new-onset POAF. (Anadolu Kard...

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“…Also, the combination of Q wave and fQRS improved the sensitivity (91.4%), specificity (89%), and negative predictable value (92.4%) for detection of scared myocardium [27].…”

Section: Discussionmentioning

confidence: 99%

QRS Fragmentation as a Prognostic Test in Acute Coronary Syndrome

Abdelrahman¹

2013

WJCS

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Background-Rationale of the Study: Among several invasive and non-invasive tests for risk stratification of acute coronary syndromes (ACS), fewer markers can be utilized in clinical practice. Our rationale is to validate use of QRS-fragmentation as a promising bed-side test for assessment of prognosis in those patients. Methods and Results: Collection of two-hundred and twenty patients with ACS was done during two years (from January 2011 till January 2013). Significant organic vaLVe disease and QRS duration ≥ 120 ms as well as patients with permanent pacemakers were excluded. Patients were subjected to full clinical examination, ECG and Echocardiography in the first day of admission followed by diagnostic coronary angiography before discharge and a nuclear study was done for Randomized sample from each group. 12-leads ECG revealed fragmentation of QRS in 74 patients and 146 patients with no QRS fragmentation. Localization of the infarct site revealed NS difference between percentages in both groups. Echocardiography revealed a significant deterioration of LV functions in group-A than group-B. Also, MR jet area was significantly higher in group-A. Coronary angiography revealed severer lesions in group-A more than group-B. Nuclear study revealed higher percentages of irreversible scars in group-A (30%) and higher reversibility in group-B (80%). In-hospital Occurrence of complications from ACS revealed a significant higher incidence of MACE in group-A. Conclusion: Presence of fragmented QRS in surface ECG during ACS represents myocardial scar or fibrosis and reflects the severity of coronary lesions and a correlation between fQRS and depression of LV function is established. Indeed, occurrence of MACE is suspected.

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Fragmented Left Sided QRS in Absence of Bundle Branch Block: Sign of Left Ventricular Aneurysm

Abstract: The sensitivity of fragmented QRS in left precordial leads for LVA was only 50%, whereas the specificity was 94.5%. It has a relatively low to moderate positive predictive value and high negative predictive value.

Cited by 47 publications

References 30 publications

Significance of a Fragmented QRS Complex Versus a Q Wave in Patients With Coronary Artery Disease

Significance of a Fragmented QRS Complex Versus a Q Wave in Patients With Coronary Artery Disease

Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery

QRS Fragmentation as a Prognostic Test in Acute Coronary Syndrome

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