Fragmented QRS as a Predictor of Appropriate Implantable Cardioverter-defibrillator Therapy

Apiyasawat, Sirin; Sahasthas, Dujdao; Ngarmukos, Tachapong; Chandanamattha, Pakorn; Likittanasombat, Khanchit

doi:10.1016/s0972-6292(16)30710-0

Cited by 7 publications

(7 citation statements)

References 18 publications

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“…Apiyasawat et al found f-QRS to be an independent predictor for appropriate ICD interventions in patients undergoing ICD therapy for various indications. 20 In their study, f-QRS was present in 19% of patients with BrS having undergone ICD therapy, and similarly, in our study 16.5% of BrS patients undergoing ICD therapy presented with f-QRS, but the presence of this abnormality was not associated with a higher rate of ICD appropriate interventions as compared with the patients without f-QRS.…”

Section: Combined Fragmented Qrs (F-qrs) and Early Repolarization Psupporting

confidence: 79%

Prevalence and Clinical Impact of Early Repolarization Pattern and QRS-Fragmentation in High-Risk Patients With Brugada Syndrome

Conte

Asmundis

Sieira

et al. 2016

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp leads has been identified as an arrhythmic marker and might indicate regional conduction disturbance in the right ventricular outflow tract (RVOT) of patients with BrS. 12 Although the presence of repolarization and depolarization abnormalities in patients with BrS has been previously assessed, in those studies only a small portion of patients were implanted with an ICD. 7,13 Conversely, f-QRS and ERP have not been systematically investigated in high-risk patients. Moreover, a previous study on BrS patients undergoing ICD therapy showed that spontaneous type 1 ECG was not an independent predictor for further arrhythmic events. 5 In addition, nearly 13% of asymptomatic patients with an ICD presented an appropriate shock during follow-up. 5 Whether the preliminary results coming from previous studies suggest that these abnormalities could have a prognostic role in BrS, no data are available on the contributing role of ERP, f-QRS or combined ERP/f-QRS rugada syndrome (BrS) is an inheritable syndrome characterized by an increased risk of sudden death (SD) in the absence of structural heart disease. 1,2 The placement of an implantable cardioverter-defibrillator (ICD) remains the only therapy with proven efficacy to prevent SD in patients with BrS at high risk for further arrhythmic events. 3-5 Although the presence of spontaneous or drug-induced coved-type STsegment elevation in the right precordial leads (V1-3) is the ECG hallmark of the syndrome, some patients show additional early repolarization signs in the inferolateral leads, or present with depolarization abnormalities. 3,6-9 Early repolarization pattern (ERP) is a recognized risk factor for ventricular arrhythmias (VAs) in patients with BrS and may appear, on 12-lead ECG, as notching of the terminal portion of the QRS complex in the inferior and/or lateral leads. 10,11 Similarly, abnormal fragmentation of the QRS complex (f-QRS) in the right precordial Background: The phenotypic heterogeneity of Brugada syndrome (BrS) can lead some patients to show an additional inferolateral early repolarization pattern (ERP), or fragmented QRS (f-QRS). The aim of the study was to investigate the prevalence and clinical impact of f-QRS, ERP or combined f-QRS/ERP in high-risk patients with BrS.

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Section: Combined Fragmented Qrs (F-qrs) and Early Repolarization Psupporting

confidence: 79%

Prevalence and Clinical Impact of Early Repolarization Pattern and QRS-Fragmentation in High-Risk Patients With Brugada Syndrome

Conte

Asmundis

Sieira

et al. 2016

Circ J

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“…Reduced LVEF and VT/VF, as has already been mentioned, often correlate with poor prognosis in patients with f-QRS. One study demonstrated that patients with f-QRS and ICD received an appropriate treatment with an ICD five times more often than patients without f-QRS [18]. Several studies have related to the issue raised by us, i.e.…”

Section: Resultsmentioning

confidence: 97%

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

et al. 2016

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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.

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“…A total of 1,637 patients (mean age: 47 ± 11 years) with BrS from eight studies (6 prospective cohort studies and 2 retrospective cohort studies) were included in our meta-analysis (Morita et al, 2008 ; Priori et al, 2012 ; Take et al, 2012 ; Maury et al, 2013 ; Apiyasawat et al, 2014 ; Tokioka et al, 2014 ; Calo et al, 2016 ; Rivard et al, 2016 ). The baseline characteristics of these studies are listed in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Five out of eight studies demonstrated that the presence of fQRS predicted future arrhythmic events in patients with a spontaneous or drug-induced type 1 ECG pattern of BrS (Morita et al, 2008 ; Priori et al, 2012 ; Take et al, 2012 ; Apiyasawat et al, 2014 ; Tokioka et al, 2014 ). On the contrary, three studied failed to show any prognostic significance of fQRS (Maury et al, 2013 ; Calo et al, 2016 ; Rivard et al, 2016 ).…”

Section: Resultsmentioning

confidence: 99%

“…Subgroup analysis was performed based on different arrhythmic endpoints, When analyzing studies using VF/SCD as a combined endpoint, pooled analysis of four studies showed that fQRS was an independent predictor of future arrhythmic events (RR 3.36, 95% CI 2.03 to 5.56, p < 0.00001) with moderate heterogeneity ( p = 0.005 and I 2 = 76%; Morita et al, 2008 ; Maury et al, 2013 ; Tokioka et al, 2014 ; Calo et al, 2016 ). When analyzing VF and SCD as different end-points, the RRs were the following: VF from three studies (RR 3.61, 95% CI 2.11 to 6.18, p < 0.00001; Priori et al, 2012 ; Take et al, 2012 ; Apiyasawat et al, 2014 ) and SCD in one study (RR 2.36, 95% CI 0.69 to 8.07, p = 0.9502; Rivard et al, 2016 ).…”

Section: Resultsmentioning

confidence: 99%

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Meta-analysis of Fragmented QRS as an Electrocardiographic Predictor for Arrhythmic Events in Patients with Brugada Syndrome

et al. 2017

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Fragmented QRS (fQRS) is an electrocardiographic marker related to ventricular fibrillation (VF) and sudden cardiac death (SCD) in various clinical settings. Current data regarding the prognostic significance of fQRS in Brugada syndrome (BrS) are contradictory. This meta-analysis aimed to evaluate the presence of fQRS as a risk stratification tool in BrS. Electronic databases (PubMed, EMBASE, and Cochrane Library) were searched until May 2016. Eight observational studies accumulating data on 1,637 BrS patients (mean age: 47 ± 11 years) were included in this meta-analysis. The mean follow-up duration ranged from 21 to 96 months. fQRS was found to be an independent predictor of future arrhythmic events in BrS (RR:3.88, 95% CI 2.26 to 6.65, p < 0.00001) with moderate heterogeneity (I2 = 54%, P = 0.03). When analyzing VF as independent end-point, the RR for VF was 3.61, and its 95% CI was 2.11 to 6.18, p < 0.00001. This meta-analysis showed that BrS patients with fQRS are at high risk for future arrhythmic events. The presence of fQRS warrants prospective evaluation as valid arrhythmogenic risk marker in BrS.

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Fragmented QRS as a Predictor of Appropriate Implantable Cardioverter-defibrillator Therapy

Cited by 7 publications

References 18 publications

Prevalence and Clinical Impact of Early Repolarization Pattern and QRS-Fragmentation in High-Risk Patients With Brugada Syndrome

Prevalence and Clinical Impact of Early Repolarization Pattern and QRS-Fragmentation in High-Risk Patients With Brugada Syndrome

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

Meta-analysis of Fragmented QRS as an Electrocardiographic Predictor for Arrhythmic Events in Patients with Brugada Syndrome

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