Fragmented QRS Complexes—A Novel but Underutilized Electrocardiograhic Marker of Heart Disease

Fares, Hassan; Heist, Kevin; Lavie, Carl J.; Kumbala, Damodar; Ventura, Héctor O.; Meadows, Renee Y.; Carter, William; Deitelzweig, Steven; Ray, Indranill Basu

doi:10.1097/hpc.0b013e31829e005d

Cited by 18 publications

(31 citation statements)

References 25 publications

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“…Myocardial fibrosis may disrupt QRS morphology and lead to fragmentation of QRS on 12-lead ECG. Accordingly, prevalence of fQRS is relatively low among the healthy general population [22] and relatively high in patients with myocardial fibrosis or scarring [11,12,13,14,23]. These data suggest that fQRS may be a useful tool for the assessment of myocardial fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy Induces Development of Fragmented QRS in Patients with Breast Cancer

et al. 2015

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Background: Myocardial fibrosis is a well-known side effect of radiotherapy. Fragmented QRS (fQRS) has been shown to be a marker of myocardial fibrosis. We postulated that radiotherapy induces development of fQRS in breast cancer patients. Patients and Methods: Breast cancer patients receiving locoregional radiotherapy were enrolled. Patients who had fQRS on electrocardiography (ECG) before radiotherapy were excluded. All patients were revaluated for the development of fQRS at 1-year follow-up. An age-matched healthy group served as controls. Results: A total of 52 breast cancer patients receiving locoregional radiotherapy were included (median age 49 years, interquartile range (IQR) 13). Of these, 19 (37%) had developed fQRS at 1-year follow-up. Compared with the control group, prevalence of fQRS was significantly higher in the irradiated group (37 vs. 12%; p < 0.002). Median total cardiac radiation dose was significantly higher in patients who had developed fQRS (5 Gy, IQR 5.2 vs. 1.7 Gy, IQR 4.4; p = 0.003). Cardiac radiation dose, entered either as a continuous variable (odds ratio (OR) 1.35, 95% confidence interval (CI) 104-1.74) or as a dichotomized variable (≥ 2.2 Gy, OR 6.48, 95% CI 1.47-28.61), was independently associated with the development of fQRS at 1-year follow-up. Conclusion: Radiotherapy for breast cancer induces development of fQRS on ECG. Cardiac radiation dose is independently associated with the development of fQRS.

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Section: Discussionmentioning

confidence: 99%

Radiotherapy Induces Development of Fragmented QRS in Patients with Breast Cancer

et al. 2015

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“…The mechanism of formation of the fQRS can be explained by significant scarring and necrosis of the myocardium (Zipes and Das, 2009; Fares et al, 2013; Jain et al, 2014). In 2006 Das et al proved by myocardial single photon emission tomography (SPECT) in a population of patients referred to a nuclear stress test that the presence of fQRS correlates to a regional myocardial scar and the sensitivity of fQRS to detect myocardial scar is significantly greater (85.6%) than the sensitivity the Q wave has (36.3%) (Das et al, 2006).…”

Section: Backgroundsmentioning

confidence: 99%

“…However, some of the pathologic processes that result in fQRS are reversible. Among the scarred tissue there can be regions of viable myocardial tissue (Zipes and Das, 2009; Fares et al, 2013) and ischemia decelerates the conduction velocity in the peri-infarct zone (Mann et al, 2015). It has been shown that fQRS may diminish from the ECG during a cardiac rehabilitation program after a STEMI and patients with hypertension (Bulut et al, 2015).…”

Section: Backgroundsmentioning

confidence: 99%

“…For example, fQRS can be exploited in identification of the arrhythmogenic right ventricular dysplasia-cardiomyopathy and detection of left ventricle aneurysms (Fares et al, 2013). When occurring ≥3 major coronary artery territories fQRS is independently associated with ventricular tachyarrhythmias (VTA) and sudden cardiac death (SCD) in patients with HCM (Debonnaire et al, 2015).…”

Section: Backgroundsmentioning

confidence: 99%

“…fQRS can also be associated with low LVEF. (Fares et al, 2013; Lorgis et al, 2014; Gong and Li, 2016; Güngör et al, 2016; Ma et al, 2016) and multi-vessel CAD in patients with STEMI (Ma et al, 2016) and NSTEMI (Güngör et al, 2016) which may explain the association with adverse prognosis. In silent MIs, which are problematic to discover in diabetics, women with unusual chest pain and in senile dementia, fQRS can be the only evidence of the ongoing event (Fares et al, 2013).…”

Section: Backgroundsmentioning

confidence: 99%

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QRS Fragmentation Patterns Representing Myocardial Scar Need to Be Separated from Benign Normal Variants: Hypotheses and Proposal for Morphology based Classification

et al. 2016

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The presence of a fragmented QRS complex (fQRS) in two contiguous leads of a standard 12-lead electrocardiogram (ECG) has been shown to be an indicator of myocardial scar in multiple different populations of cardiac patients. QRS fragmentation is also a predictor of adverse prognosis in acute myocardial infarction, coronary artery disease, and ischemic cardiomyopathy and a prognostic tool in structural heart diseases. An increased risk of sudden cardiac death associated with fQRS has been documented in patients with ischemic cardiomyopathy and hypertrophic cardiomyopathy. However, fQRS is also frequently observed in apparently healthy subjects. Thus, a more detailed classification of different QRS fragmentations is needed to identify the pathological fragmentation patterns and refine the role of fQRS as a risk marker of adverse cardiac events and sudden cardiac death. In most studies fQRS has been defined by the presence of an additional R wave (R′), or notching in the nadir of the S wave, or the presence of >1 R′ in two contiguous leads corresponding to a major coronary territory. However, this approach does not discriminate between minor and major fragmentations and the location of the fQRS is also neglected. In addition to this, the method is susceptible to large interobserver variability. We suppose that some fQRS subtypes result from conduction delays in the His-Purkinje system, which is a benign finding and thus can weaken the prognostic values of fQRS. The classification of fQRSs to subtypes with unambiguous definitions is needed to overcome the interobserver variability related issues and to separate fQRSs caused by myocardial scarring from benign normal variants. In this paper, we review the anatomic correlates of fQRS and the current knowledge of prognostic significance of fQRS. We also propose a detailed fQRS classification for research purposes which can later be simplified after the truly pathological morphologies have been identified. The research material of our study consist of 15,245 ECGs from the random general population and approximately six thousands (n = 6,241) ECGs from subjects with a known cardiac disease.

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Early echocardiographic and electrophysiological characteristics of subclinical hyperthyroidism

Kerkhof

Handly

2023

J of Clinical Ultrasound

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Fragmented QRS Complexes—A Novel but Underutilized Electrocardiograhic Marker of Heart Disease

Cited by 18 publications

References 25 publications

Radiotherapy Induces Development of Fragmented QRS in Patients with Breast Cancer

Radiotherapy Induces Development of Fragmented QRS in Patients with Breast Cancer

QRS Fragmentation Patterns Representing Myocardial Scar Need to Be Separated from Benign Normal Variants: Hypotheses and Proposal for Morphology based Classification

Early echocardiographic and electrophysiological characteristics of subclinical hyperthyroidism

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