Incremental Changes in QRS Duration Predict Mortality in Patients with Atrial Fibrillation

Lin, Yang; Liu, Yen‐Bin; Chu, Ching-Chi

doi:10.1111/j.1540-8159.2009.02508.x

Cited by 7 publications

(4 citation statements)

References 31 publications

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“…It remains to be established whether dynamic changes in QRS duration can predict risk. Small retrospective studies have suggested that incremental changes in QRS duration offer independent prognostic value, and perform better than absolute values of QRS duration in predicting prognosis . Our study confirmed that a change in QRS duration over the first year of follow‐up was associated with increased mortality and hospitalization.…”

Section: Discussionsupporting

confidence: 81%

ECG Features Associated With Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation: A Combined AFFIRM and AF‐CHF Analysis

Andrade

Roy

Wyse

et al. 2016

Cardiovasc electrophysiol

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Section: Discussionsupporting

confidence: 81%

ECG Features Associated With Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation: A Combined AFFIRM and AF‐CHF Analysis

Andrade

Roy

Wyse

et al. 2016

Cardiovasc electrophysiol

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“…Atrial fibrillation is also common in chronic dialysis patients, and QRS duration could be an important outcome-predictor in those with atrial fibrillation ( Lin, Liu & Chu, 2009 ; Chao et al, 2012 ). Similarly, chronic dialysis patients are at risk of developing left ventricular hypertrophy (LVH), and existing literature identified a potential association between LVH and QRS prolongation, especially in hypertensive patients ( Budhwani, Patel & Dwyer, 2005 ).…”

Section: Discussionmentioning

confidence: 99%

Frailty severity is significantly associated with electrocardiographic QRS duration in chronic dialysis patients

Chao

Huang

2015

PeerJ

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End-stage renal disease (ESRD) patients are at increased risk of sudden cardiac death, the risk of which is presumably related to arrhythmia. Electrocardiographic (ECG) parameters have been found to correlate with arrhythmia and predict cardiovascular outcomes in ESRD patients. Frailty is also a common feature in this population. We investigate whether the severity of dialysis frailty is associated with ECG findings, including PR interval, QRS duration, and QTc interval. Presence and severity of frailty was ascertained using six different self-report questionnaires with proven construct validity. Correlation analysis between frailty severity and ECG was made, and those with significant association entered into multiple regression analysis for confirmation. Among a cohort of chronic hemodialysis patients, we found that frailty severity, assessed by the Edmonton frailty scale, is significantly associated with QRS duration (r = − 0.3, p < 0.05). Dialysis patients with QRS longer than 120 ms had significantly lower severity of frailty than those with QRS less than 120 ms (p = 0.01 for the Edmonton frailty scale and 0.05 for simple FRAIL scale). Regression analysis showed that frailty severity, assessed by the Edmonton frailty scale and simple FRAIL scale, was significantly associated with QRS duration independent of serum electrolyte levels. In conclusion, a significant relationship exists between the severity of frailty and QRS duration in ESRD patients. This might be an under-recognized link between frailty and its adverse cardiovascular impact in these patients.

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“…The preimplantation QRSd (QRSd pre ) was measured from the earliest onset to the latest deflection of the QRS complex. [ 8 ] The paced QRSd (QRSd paced ) was measured from the beginning of the ventricular pacing spike to the end of the QRS complex. [ 9 ] In each lead, the mean value for 3 consecutive complexes was defined as the final QRSd.…”

Section: Methodsmentioning

confidence: 99%

“…The QRSd max was measured from the earliest onset in any lead to the latest deflection in any lead. [ 8 ] The QRSd variation was measured by subtracting the QRSd pre from the QRSd paced (QRSd paced – QRSd pre ).…”

Section: Methodsmentioning

confidence: 99%

Association between paced QRS duration and atrial fibrillation after permanent pacemaker implantation

Xing

Jiang

et al. 2018

Medicine

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Right ventricular pacing often results in prolonged QRS duration (QRSd) as the result of right ventricular stimulation, and atrial fibrillation (AF) may result. The association of pacing-induced prolonged QRSd and AF in patients with permanent pacemakers is unknown.We selected 180 consecutive patients who underwent pacemaker implantation for complete/advanced atrioventricular block. All of the patients were paced from the right ventricular septum. Electrocardiography recordings were obtained at the beginning and the end of pacemaker implantation. QRSd was measured in all 12 leads. The QRSd variation was calculated by subtracting the preimplantation QRSd from the postimplantation QRSd.The occurrence of AF was observed in 64 (35.56%) patients (follow-up 33.62 ± 21.47 mo). No significant differences in preimplantation QRSd were observed between the AF occurrence and nonoccurrence groups. The QRSd variation in leads V4 (54.22 ± 29.03 vs 42.66 ± 33.79 ms, P = .022), and V6 (64.62 ± 23.16 vs 48.45 ± 34.40 ms, P = .001) differed significantly between the occurrence and nonoccurrence groups. More QRSd variation in lead V6 (P = .005, HR = 1.822, 95% CI 1.174–2.718, interval scale of QRSd was 40 ms) and left atrial diameter (P = .045, HR = 1.042, 95% CI 1.001–1.086) were independent risk factors for AF occurrence. Receiver operating characteristic curve suggested that QRSd variation in lead V6 could predict AF occurrence, especially for patients with long preimplantation QRSd (≥120 ms, area under the curve was 0.826, 95% CI 0.685–0.967).QRSd variation in lead V6 might be positively correlated with postimplantation AF occurrence. In patients with pacemaker implantation, QRSd could be a complementary criterion for optimizing the right ventricular septal pacing site, and smallest QRSd might be worth pursuing.

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Incremental Changes in QRS Duration Predict Mortality in Patients with Atrial Fibrillation

Abstract: A progressive increase in QRS duration predicted a poor prognosis in patients with AF in our study. A prospective study is needed to substantiate the prognostic value of QRS prolongation in AF patients.

Cited by 7 publications

References 31 publications

ECG Features Associated With Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation: A Combined AFFIRM and AF‐CHF Analysis

ECG Features Associated With Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation: A Combined AFFIRM and AF‐CHF Analysis

Frailty severity is significantly associated with electrocardiographic QRS duration in chronic dialysis patients

Association between paced QRS duration and atrial fibrillation after permanent pacemaker implantation

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