Fragmented QRS: A predictor of mortality and sudden cardiac death

Das, Mithilesh K.; Zipes, Douglas P.

doi:10.1016/j.hrthm.2008.10.019

Cited by 204 publications

(186 citation statements)

References 31 publications

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“…These fragmentations on surface ECG were associated with increased adverse cardiovascular events (CVEs) in previous studies (2)(3)(4)(5). 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

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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: 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

show abstract

“…Previous studies have shown that fQRS is a predictor of cardiovascular events in a variety of populations (8,11). The cardiovascular events increasing effect is thought to be associated with myocardial scarring and/or the presence of fibrosis, leading to nonhomogeneous myocardial electrical activity (9).…”

Section: Discussionmentioning

confidence: 99%

“…The cardiovascular events increasing effect is thought to be associated with myocardial scarring and/or the presence of fibrosis, leading to nonhomogeneous myocardial electrical activity (9). Indeed, studies have revealed that the presence of fQRS is correlated with cardiac structural abnormality, ventricular arrhythmia, myocardial scarring and fibrosis (8)(9)(10)(11) studies showing an association between presence of fQRS and myocardial function and prognosis in patients with NS, Perlini et al (25) demonstrated elevated fQRS in patients with AL amyloidosis and showed that this was correlated with prognosis. AL amyloidosis is a clinical picture observed together with renal and cardiac involvement and one that can lead to NS.…”

Section: Discussionmentioning

confidence: 99%

“…Studies to date have shown that presence of fQRS is associated with a rise in cardiovascular event incidence and cardiovascular mortality and morbidity. This association is thought to stem from myocardial scarring, ventricular arrhythmia and structural cardiac defects (7)(8)(9)(10)(11). There are no previous studies evaluating the relationship between presence of fQRS and myocardial functions in NS patients.…”

Section: Introductionmentioning

confidence: 99%

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Presence of fragmented QRS and its correlation with myocardial performance index in patients with nephrotic syndrome

Özkan

Adar²,

Ulusoy³

et al. 2014

Anadolu Kardiyol Derg

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Objective: More cardiovascular events are seen in nephrotic syndrome (NS) patients than in the normal population. Fragmented QRS (fQRS) includes various RSR' patterns with different morphologies of the QRS complexes with or without the Q wave on a resting 12-lead ECG. A relationship between the presence of fQRS and myocardial function impairment has been shown in several studies. The purpose of this study was to evaluate the presence of fQRS in this patient group and the relationship with myocardial functions. Methods: Thirty-four NS patients were included in the cross-sectional study. Demographic data were recorded, and electrocardiograms (ECGs) were analyzed for the presence of fQRS following investigation of biochemical parameters and 24-h protein excretion. In addition to classic echocardiographic parameters, the myocardial performance (Tei index) was calculated as an indicator of cardiac function. For comparison of group's data Student's t-test and Mann-Whitney U test were used. Multiple linear regression analysis was performed for parameters affecting presence of fQRS. Results: We identified fQRS in half of our patients group. Patients with fQRS had significantly greater proteinuria level and Tei index than those without (p<0.05 and p<0.001, respectively). Tei index was also affected presence of fQRS (p<0.05, β=0.45, R 2 =0.32) and positively correlated with proteinuria levels (p<0.05 r=0.366). Conclusion: We demonstrated, for the first time in the literature, that the determination of fQRS in patients with NS in surface ECG, an easily accessible technique, can be used as a parameter in the prediction of myocardial functions. (Anadolu Kardiyol Derg 2014; 14: 450-5)

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“…For signs of WPW configuration we looked for a short PQ interval together with a delta wave. Finally, we looked for signs of fragmentation in the QRS complex defined as a slurring and slight prolongation of the final portion of the QRS complex without necessarily producing a broadening of the QRS complex [16]. Early repolarization was defined as an elevation of the J point at least 1 mm above the baseline level, either as QRS slurring (a smooth transition from the QRS segment to the ST segment) or notching (a positive J deflection inscribed on the S wave) in the inferior lead (II, III, and aVF), lateral leads (I, aVL), and V3 to V6 [11].…”

Section: Ecg Analysesmentioning

confidence: 99%

ECG is not a reliable predictor of sudden cardiac death in the general population

Theilade¹,

Pecini²,

Marott³

et al. 2013

WJCD

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Objectives: To determine the predictive value of the ECG for sudden death in the general population. Design: In the Copenhagen City Heart Study, a randomly selected population sample in Copenhagen, Denmark has been followed prospectively since 1976. From this population sample, we analyzed ECGs of individuals who had suffered sudden cardiac death (SCD) before the age of 50 years and compared them with ECGs of a randomly selected control individuals from the same population sample. Specific ECG signs that could point toward a condition associated with a risk of SCD were noted. Results: From a total of 18,974 individuals in the cohort, 207 had died at an age younger than 50 years. Among these, 24 persons with SCD were identified. The most prevalent ECG abnormality was QRS fragmentation. We found no ECGs with long or short QTc, Brugada sign or WPW. The prevalence of signs of left ventricular hypertrophy, early repolarization, or fragmentation was not different from the prevalence of these signs in the control group. Conclusion: In the Copenhagen City Heart Study, the ECG failed to predict SCD in persons who died before the age of 50 years.

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Fragmented QRS: A predictor of mortality and sudden cardiac death

Cited by 204 publications

References 31 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

Presence of fragmented QRS and its correlation with myocardial performance index in patients with nephrotic syndrome

ECG is not a reliable predictor of sudden cardiac death in the general population

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