Fragmented QRS Complex: A Novel Marker of Cardiovascular Disease

Chatterjee, Saurav; Changawala, Nisarg

doi:10.1002/clc.20709

Cited by 74 publications

(59 citation statements)

References 19 publications

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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).…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…The reason of documented association between fragmented QRS (fQRS) and increased morbidity and mortality, sudden cardiac death and recurrent CVEs were investigated by several studies (4)(5)(6)(7)(8)(9)(10). In these studies, the main causative mechanism of fQRS was cardiac fibrosis (11,12).…”

Section: Introductionmentioning

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

View full text Add to dashboard Cite

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“…The RSR' patterns are sub-classified into fQRS complexes and fragmented wide complexes based on QRS duration [4]. A classic fQRS is only a narrow complex with duration less than 120 ms [16].…”

Section: Fragmented Qrs Vs F-w-qrs Complexesmentioning

confidence: 99%

“…As this new parameter (fragmented QRS [fQRS]) is an easily evaluated ECG sign, it has attracted much attention as a potentially diagnostic and/or prognostic tool for myocardial scar identification in recent years. This novel marker includes various RSR' patterns, and based on the complex duration has been sub classified into two major groups: fQRS complex (< 120 ms duration) and fragmented wide complex (f-wQRS) [4]. Fragmented QRS as defined by Das et al [5] includes only the narrow complexes with the presence of initial R wave followed by an S wave and a terminal positive deflection (R') on a resting 12-lead ECG.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of fragmented QRS complex in myocardial scar detection: systematic review and meta-analysis of the literature

et al. 2016

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A b s t r a c t Background and aim:The present study aimed to investigate the diagnostic value of fragmented QRS complex (fQRS) on 12-lead electrocardiogram (ECG) for myocardial scar detection, and presented the results in a systematic review and meta-analysis format.Methods: Medline, SCOPUS, and ISI Web of Knowledge were searched electronically with "Fragmented QRS" or "fQRS" as key words. All related studies that had evaluated the accuracy of fQRS for myocardial scar diagnosis were included.Results: Eight studies (2560 patients) were finally included in the systematic review. Specificity assessment could be evaluated only by five out of these eight articles. Overall pooled sensitivity of fQRS, Q wave, and mixed Q-fQRS was 68% (65-71), 51% (47-55), and 74% (69-79) and the pooled specificity was 80% (79-81), 97% (97-98) and 92% (91-93), respectively. Conclusions:Fragmented QRS is a novel ECG marker with more sensitivity and less specificity than Q wave. A combination of fQRS with Q wave in a 12-lead ECG results in up to 74% sensitivity and 92% specificity. Additional studies are needed to assess the significance of this ECG parameter for regional myocardial scar detection.

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“…У пациентов с некоронарогенными заболе-ваниями миокарда (миокардиты, аритмогенная кар-диомиопатия/дисплазия правого желудочка (АК/ ДПЖ) и др.) миокардиальный фиброз также может приводить к замедленной и негомогенной деполяри-зации, что проявляется на ЭКГ в виде fQRS [1].…”

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QRS Complex Fragmentation — An Important Marker of Abnormal Depolarization

Пармон¹,

Гордеева²,

Kurilenko³

et al. 2017

Russ J Cardiol

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Цель. Целью работы являлось изучение фрагментации qRs-комплекса (fqRs) у пациентов с идиопатическими желудочковыми нарушениями ритма (ЖНР). Материал и методы. 125 пациентов были разделены на 2 группы: 1-ая группа -100 пациентов (46,4±14,1 лет, 69 женщин) с идиопатическими ЖНР. У пациентов преобладал дневной тип аритмии (63%), чаще регистрировались мономорфные желудочковые экстрасистолические комплексы (ЖЭК) (59%), у 39% обследованных -пароксизмы неустойчивой желудочковой тахикардии. Структурная патология миокарда была исключена на основании данных элек-трокардиографии, эхокардиографии, в ряде случаев -магнитно-резонанс-ной томографии сердца. 2-ая контрольная группа -25 пациентов (69,0±11 лет, 12 женщин) с ЖНР на фоне ишемической болезни сердца (инфаркт мио-карда в анамнезе). В этой группе преобладали полиморфные (84%) дневные (68%) ЖЭК, у 25% -неустойчивая желудочковая тахикардия. Анализ проводился с помощью холтеровского мониторирования ЭКГ (ХМ-ЭКГ) в 12-ти отведениях ("KtResult 2", ЗАО "Инкарт"). Результаты. В 1-ой группе fqRs синусовых комплексов была зарегистриро-вана у 2 пациентов (2% обследованных) и носила преходящий характер. Зако-номерности в суточной динамике fqRs выявлено не было. FqRs в ЖЭК реги-стрировалась у 25 пациентов (25% обследованных). У одного пациента была выявлена и fqRs синусовых комплексов, и fqRs ЖЭК. У 17 пациентов (68%) регистрировалась fqRs ЖЭК. Во 2-ой контрольной группе fqRs синусового комплекса зарегистрирована у 6 пациентов (24%), fqRs ЖЭК -у 23 пациентов (92%) и носила постоянный характер. Заключение. Феномен fqRs может быть выявлен при рутинном инструмен-тальном обследовании (во время стандартной электрокардиографии (ЭКГ) и при проведении ХМ-ЭКГ), чаще регистрируется у пациентов с ИБС и явля-ется важным критерием оценки процессов реполяризации. Выявление fqRs у пациентов с идиопатическими ЖНР, вероятно, обусловлено дисбалансом автономной нервной системы, который создает условия для формирования электрической нестабильности миокарда. Нельзя исключить, что fqRs может являться ранним маркером кардиомиопатий. Необходимо дальнейшее изуче-ние данного феномена для определения его места в риск-стратификации внезапной сердечной смерти у пациентов без структурной патологии сердца. QRS COMpLEX FRAGMENTATION -AN IMpORTANT MARKER OF AbNORMAL DEpOLARIZATIONParmon E. V., Gordeeva M. s., Kurilenko t. A., Berngardt E. R.Aim. to investigate on the qRs complex fragmentation (fqRs) in patients with idiopathic ventricular arrhythmias (VA) . Material and methods. totally, 125 patients, selected into 2 groups: 1st group -100 patients (mean age 46,4±14,1 y., 69 females) with idiopathic VRD. Patients had predominating daytime arrhythmia (63%), more oftenly -monomorphic ventricular exstrasystolic complexes (VE) (59%), in 39% patients -paroxysms of nonsustained ventricular tachicardia. structural pathology of myocardium was ruled out based on electrocardiography data, echocardiography, in some cases -magnetic resonance. second, control group -25 pts. (69,0±11 y. o., 12 females) with VRD of ischemic orig...

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Fragmented QRS Complex: A Novel Marker of Cardiovascular Disease

Cited by 74 publications

References 19 publications

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

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

Diagnostic value of fragmented QRS complex in myocardial scar detection: systematic review and meta-analysis of the literature

QRS Complex Fragmentation — An Important Marker of Abnormal Depolarization

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