The presence of fragmented QRS may predict the recurrence of nonvalvular atrial fibrillation after successful electrical cardioversion

Eren, Hayati; Kaya, Ülker; Öcal, Lütfi; Şenbaş, Ahmet; Kalçık, Macit

doi:10.1111/anec.12700

Cited by 5 publications

(5 citation statements)

References 42 publications

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“…Canpolat et al also demonstrated that fQRS morphology is significantly related to left atrial scar in patients with permanent AF 12 . Another study conducted by Eren et al revealed that the presence of fQRS morphology may be associated with AF recurrence following electrical cardioversion 13 . What is more, Yesin et al reported that the presence of fQRS morphology in STEMI patients is a significant predictor of AF that may develop after primary coronary intervention 14 .…”

Section: Discussionmentioning

confidence: 98%

“…Atrium-related markers such as P wave duration (P) and P dispersion (Pd) were used while investigating ECG markers that could predict the development of AF 9 . However, in recent studies, it was reported that fragmented QRS (fQRS) morphology, which is accepted as an indicator of myocardial fibrosis, heterogeneous depolarization and chronic ischemia, may be a predictor of AF [10][11][12][13][14] . To the best of our knowledge, there is a lack of literature on the relationship of atrial and ventricular ECG markers and fQRS with the risk of developing AF in HD patients.…”

Section: Introductionmentioning

confidence: 99%

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Association of Fragmented QRS Morphology With Risk of Atrial Fibrillation in Hemodialysis Patients

Aksu

2020

Dicle Tıp Dergisi

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Objective: Atrial fibrillation (AF) is the most common form of arrhythmia in hemodialysis (HD) patients. Fragmented QRS (fQRS) morphology has been proposed as an ECG marker to predict the risk of paroxysmal AF in various conditions. In this study, we aimed to investigate the association between risk of AF development and P dispersion (Pd) and fQRS morphology in HD patients.Methods: After analyzing the 24-hour Holter recordings of the patients, they were divided into 3 groups as without atrial runs (WAR), short atrial runs (SAR), and silent paroxysmal atrial fibrillation episode (SPAFE). In ECGs taken before HD, the presence of fQRS morphology was investigated, and Pd was measured.Results: As a result of the analysis of the 24-hour Holter ECG recordings, it was determined that 12 of the 74 patients had SAR, while 6 had SPAFE. The duration of hemodialysis was significantly longer in the SPAFE groups than the WAR group (p=0.026). It was found that fQRS morphology could be an independent predictor of SAR (odds ratio=0.056; 95% CI, 0.006-0.548; p=0.013). The incidence of fQRS morphology was significantly higher in the SPAFE group than the WAR group (p=0.002). However, this significance did not continue in the multivariate analysis. Pd was similar between the groups. Conclusion:This retrospective study is the first study that investigated the association of fQRS morphology with SAR and SPAFE in HD patients, and it showed that fQRS morphology may be useful in distinguishing HD patients with a high AF risk.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Association of Fragmented QRS Morphology With Risk of Atrial Fibrillation in Hemodialysis Patients

Aksu

2020

Dicle Tıp Dergisi

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“…Eren and colleagues revealed that the presence of fragmented QRS was an independent predictor of AF recurrence (hazard ratio 9.670, 95% CI 4.714-19.837, P < 0.001) after successful cardioversion in patients with persistent non-valvular AF. 18 In a cohort of 502 patients with persistent AF referred for cardioversion, after 1 year follow-up, the rate of sinus rhythm maintenance was found to be 32%. The main predictors of sinus rhythm maintenance included the use of anti-arrhythmic agents.…”

Section: Discussionmentioning

confidence: 99%

Predictors of long-term outcomes in patients with persistent atrial fibrillation undergoing electrical cardioversion

Dehghani,

Safarzadeh,

Shariati

et al. 2024

J Cardiovasc Thorac Res

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Introduction: Cardioversion for atrial fibrillation (AF) is routinely implemented in daily practice; however, it can be associated with the development of recurrent AF. In this study we aimed to evaluate the predictors of AF recurrence after electrical cardioversion, and to compare the outcomes of patients with or without AF recurrence during follow-up. Methods: Patients with persistent AF were enrolled from March 2015 to September 2018. Patients with recurrent AF within 6 months after the index cardioversion were considered as AF recurrence (AFR) group, and those with normal sinus rhythm were defined as normal sinus rhythm (NSR) group. Thereafter, all patients were followed up for the incidence of adverse events, including death, requiring dialysis, coronary artery intervention/surgeries, cerebrovascular events, heart failure, and recurrent AF beyond 6 months. Results: Of 129 patients, 11 patients had failed cardioversion and 7 patients lost to follow-up. So, 34 and 77 patients were categorized as the NSR and the AFR groups. During a median follow-up time of 54 (46-75) months, there was a trend for a higher incidence of major adverse events in the AFR group compared to the NSR group (P=0.063). Lower body mass index (odds ratio [OR] 0.885, 95% confidence interval [CI] 0.794-0.986, P=0.027) and coarse AF before the index cardioversion (OR 3.846, 95% CI 1.189-12.443, P=0.025) were the independent predictors of recurrent AF. Conclusion: In patients with persistent AF undergoing cardioversion, the presence of coarse AF and the lower values of body mass index were found to be associated with the AF recurrence.

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“…As with LAE, the high fQRS rate may partly be explained by the high rate of cardiovascular comorbidities in our study population since fQRS has been associated with diabetes, CAD and, vascular calcification in prior reports [ 8 , 18 , 22 ]. In recent studies, fQRS has been linked to the incidence of new-onset AF in patients with established heart disease, as well as to increased AF recurrence after cardioversion or catheter ablation [ 8 , 9 , 19 , 23 , 24 ]. It is unclear why no association between AF and fQRS was observed among patients with severe CKD in this study.…”

Section: Discussionmentioning

confidence: 99%

Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

Hellman

Hakamäki

Lankinen

et al. 2020

BMC Cardiovasc Disord

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Background The prevalence of left atrial enlargement (LAE) and fragmented QRS (fQRS) diagnosed using ECG criteria in patients with severe chronic kidney disease (CKD) is unknown. Furthermore, there is limited data on predicting new-onset atrial fibrillation (AF) with LAE or fQRS in this patient group. Methods We enrolled 165 consecutive non-dialysis patients with CKD stage 4–5 without prior AF diagnosis between 2013 and 2017 in a prospective follow-up cohort study. LAE was defined as total P-wave duration ≥120 ms in lead II ± > 1 biphasic P-waves in leads II, III or aVF; or duration of terminal negative portion of P-wave > 40 ms or depth of terminal negative portion of P-wave > 1 mm in lead V1 from a baseline ECG, respectively. fQRS was defined as the presence of a notched R or S wave or the presence of ≥1 additional R waves (R’) or; in the presence of a wide QRS complex (> 120 ms), > 2 notches in R or S waves in two contiguous leads corresponding to a myocardial region, respectively. Results Mean age of the patients was 59 (SD 14) years, 56/165 (33.9%) were female and the mean estimated glomerular filtration rate was 12.8 ml/min/1.73m2. Altogether 29/165 (17.6%) patients were observed with new-onset AF within median follow-up of 3 [IQR 3, range 2–6] years. At baseline, 137/165 (83.0%) and 144/165 (87.3%) patients were observed with LAE and fQRS, respectively. Furthermore, LAE and fQRS co-existed in 121/165 (73.3%) patients. Neither findings were associated with the risk of new-onset AF within follow-up. Conclusion The prevalence of LAE and fQRS at baseline in this study on CKD stage 4–5 patients not on dialysis was very high. However, LAE or fQRS failed to predict occurrence of new-onset AF in these patients.

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The presence of fragmented QRS may predict the recurrence of nonvalvular atrial fibrillation after successful electrical cardioversion

Cited by 5 publications

References 42 publications

Association of Fragmented QRS Morphology With Risk of Atrial Fibrillation in Hemodialysis Patients

Association of Fragmented QRS Morphology With Risk of Atrial Fibrillation in Hemodialysis Patients

Predictors of long-term outcomes in patients with persistent atrial fibrillation undergoing electrical cardioversion

Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

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