Predictive value of fragmented QRS in primary prevention implantable cardioverter defibrillator recipients with left ventricular dysfunction

Forleo, Giovanni B.; Rocca, Domenico G. Della; Papavasileiou, Lida P.; Panattoni, Germana; Sergi, Domenico; Duro, Lucia; Mahfouz, Karim; Magliano, Giulia; Santini, Luca; Romeo, Francesco

doi:10.2459/jcm.0b013e32834ae458

Cited by 23 publications

(29 citation statements)

References 25 publications

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“…Fragmented QRS was not associated with increased risk of all-cause mortality, arrhythmic mortality and non-arrhythmic mortality. Similar conclusions were drawn from studies by Forleo et al [36].…”

Section: Discussionsupporting

confidence: 79%

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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Section: Discussionsupporting

confidence: 79%

QRS Fragmentation as a Prognostic Test in Acute Coronary Syndrome

Abdelrahman¹

2013

WJCS

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“…At 16.6 ± 10.2 months follow-up, fQRS was found to be a predictor of arrhythmic events, but not mortality. Additionally, in a retrospective study, Forleo et al 10 found that fQRS did not predict the arrhythmic events and mortality. Cheema et al 9 evaluated the association of fQRS with all-cause and arrhythmic mortality in 842 patients with moderate to severe left ventricular systolic dysfunction (ischemic or nonishemic etiology).…”

Section: Discussionmentioning

confidence: 97%

“…3 Fragmented QRS complex (fQRS), as a noninvasive prognostic marker on resting electrocardiography (ECG) emerged as a diagnostic and/or prognostic marker in several cardiovascular conditions. [8][9][10][11][12][13] So, in this study, we aimed to investigate the association of appropriate ICD shocks and all-cause mortality with the presence and extent of fQRS in patients with systolic heart failure who underwent ICD implantation for primary prophylaxis previously. [8][9][10][11][12][13] So, in this study, we aimed to investigate the association of appropriate ICD shocks and all-cause mortality with the presence and extent of fQRS in patients with systolic heart failure who underwent ICD implantation for primary prophylaxis previously.…”

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confidence: 99%

Fragmented QRS Predicts the Arrhythmic Events in Patients with Heart Failure Undergoing ICD Implantation for Primary Prophylaxis: More Fragments More Appropriate ICD Shocks

Özcan

Turak

Canpolat

et al. 2014

Ann Noninvasive Electrocardiol

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“…Fragmentation of the QRS complex (f‐QRS) on the 12‐lead electrocardiogram (ECG), defined as the presence of additional notches buried within the QRS, reflects derangement of ventricular conduction due to myocardial scar or fibrosis . f‐QRS may be associated with prior myocardial infarction, left ventricular dysfunction, and adverse arrhythmic events in various cardiac diseases; however, their utility to risk stratification strategies remains unclear . Addressing as yet unresolved issues in the evaluation of whether and to what extent heart rate change or/and mode of pacing affects the detection of f‐QRS might help to improve SCD risk prediction with the simple, inexpensive and easily available ECG.…”

Section: Introductionmentioning

confidence: 99%

Effect of heart rate and pacing mode on QRS fragmentation

Zagkli

Despotopoulos

Spiliotopoulos

et al. 2018

Journal of Arrhythmia

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BackgroundThe study was designed to investigate the effect of heart rate and pacing mode on QRS fragmentation (f‐QRS). Moreover, the usefulness of f‐QRS in distinguishing patients with impaired left ventricular ejection function (EF) and ventricular tachycardia (VT) from patients with normal EF was assessed.MethodsThree hundred and six recipients, with dual‐chamber device, with intrinsic narrow or wide QRS complex and preserved atrioventricular conduction were grouped into normal‐EF or impaired‐EF VT. We analyzed intrinsic narrow f‐QRS and wide f‐QRS as well as ventricular‐paced f‐QRS following different heart rates (baseline, 100 bpm) and pacing modes.ResultsIn the baseline state, overall, patients with impaired‐EF VT (35 ± 9%), compared to those with normal‐EF, had more f‐QRS (56% vs 27%, P < .001) and ventricular‐paced f‐QRS (62% vs 16%, P < .0001). Ventricular pacing conferred both at baseline and at higher heart rate more ventricular‐paced f‐QRS in patients with impaired‐EF VT than in normal‐EF (P < .001). Detection of ventricular‐paced f‐QRS markedly improved overall specificity (84%) and positive predictive value (91%) in identifying patients with impaired‐EF VT.ConclusionsIncreased heart rate or/and ventricular pacing uncover QRS fragmentations. Detection of ventricular‐paced f‐QRS adds value toward noninvasive identification of patients with impaired‐EF VT.

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Predictive value of fragmented QRS in primary prevention implantable cardioverter defibrillator recipients with left ventricular dysfunction

Abstract: In ICD recipients for primary prevention of SCD, fQRS is not helpful in selecting a subgroup of patients who benefit from prophylactic ICD implantation.

Cited by 23 publications

References 25 publications

QRS Fragmentation as a Prognostic Test in Acute Coronary Syndrome

QRS Fragmentation as a Prognostic Test in Acute Coronary Syndrome

Fragmented QRS Predicts the Arrhythmic Events in Patients with Heart Failure Undergoing ICD Implantation for Primary Prophylaxis: More Fragments More Appropriate ICD Shocks

Effect of heart rate and pacing mode on QRS fragmentation

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