Fragmented QRS as a predictor of cardiac events in patients with cardiac sarcoidosis

Ogura, Sayoko; Nakamura, Kazufumi; Morita, Hiroshi; Nakagawa, Koji; Nishii, Nobuhiro; Akagi, Satoshi; Toh, Norihisa; Takaya, Yoichi; Yoshida, Masashi; Miyoshi, Toru; Watanabe, Atsuyuki; Ito, Hiroshi

doi:10.1016/j.jjcc.2021.10.022

Cited by 5 publications

(13 citation statements)

References 21 publications

(34 reference statements)

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“…86 It has been shown to be a marker of localized scar 86 and to be associated with increased risk of arrhythmic mortality and SCD 87 in a variety of populations. [88][89][90] A recent study has shown that fQRS was associated with complex VA in patients with MVP (Table 2). 91 Further research is needed to determine the sensitivity and specificity of this feature in MVP patients as well as its role in clinical practice.…”

Section: T Wave Inversionmentioning

confidence: 97%

EHRA expert consensus statement on arrhythmic mitral valve prolapse and mitral annular disjunction complex in collaboration with the ESC Council on valvular heart disease and the European Association of Cardiovascular Imaging endorsed cby the Heart Rhythm Society, by the Asia Pacific Heart Rhythm Society, and by the Latin American Heart Rhythm Society

Sabbag

Essayagh

Barrera³

et al. 2022

EP Europace

112

144

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Risk stratification scheme. Risk stratification aiming at assessing the risk of VAs and SCD in patients with MVP, involving two phases based on the clinical and imaging context and the uncovered arrhythmia. In the absence of ventricular tachycardia, phenotypic risk features will trigger the intensity of screening for arrhythmia. Green boxes indicate green heart consensus statements and yellow boxes indicate yellow heart consensus statements. High risk -sustained VT, polymorphic NSVT, fast (>180 bpm) NSVT, VT/NSVT resulting in syncope. ICD = implantable cardioverter defibrillator; LA = left atrium; LGE = late gadolinium enhancement; LV-EF = left ventricular ejection fraction; MAD = mitral annular disjunction; MV = mitral valve; PVCs = premature ventricular contractions; TWI = T-wave inversion; VT = ventricular tachycardia. #Additional ECG monitoring method may be used such as loop recorders.

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Section: T Wave Inversionmentioning

confidence: 97%

EHRA expert consensus statement on arrhythmic mitral valve prolapse and mitral annular disjunction complex in collaboration with the ESC Council on valvular heart disease and the European Association of Cardiovascular Imaging endorsed cby the Heart Rhythm Society, by the Asia Pacific Heart Rhythm Society, and by the Latin American Heart Rhythm Society

Sabbag

Essayagh

Barrera³

et al. 2022

EP Europace

112

144

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“…Extended and significant QRS fragmentation and epsilon waves were unique ECG findings representing remarkable depolarization abnormalities in patients with ES. Patients with fQRS experienced more frequent VTA episodes compared to those experienced by patients without fQRS 23 . The present study focused on patients with VTAs, and the incidences of fQRS and positive late potentials did not differ between the two groups.…”

Section: Discussionmentioning

confidence: 69%

“…Fibrosis and inflammation detected using CMR and FDG‐PET are powerful predictors of VTAs and SCD 3,4,6,7 . ECG signs indicating conduction abnormalities, such as AV node dysfunction, BBB, and fQRS, are also associated with VTA events and SCD 18,22,23 . PES can be used to identify high‐risk patients for VTs, appropriate ICD therapies, and SCD 8 …”

Section: Discussionmentioning

confidence: 99%

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Significant delayed conduction and characteristic ventricular tachycardias in patients with cardiac sarcoidosis and electrical storm

Morita,

Nakagawa,

Ueoka

et al. 2023

Cardiovasc electrophysiol

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IntroductionElectrical storm (ES) of ventricular tachyarrhythmias (VTAs) is an important cause of sudden death in patients with cardiac sarcoidosis (CS). VTAs in CS are associated with myocardial scarring and inflammation. However, little is known about the risk factors of ES in patients with CS and VTAs. The objective of this study is to clarify the characteristics and risk factors for the development of ES in patients with CS.MethodsThe study population included consecutive 52 patients with CS and sustained VTA. Twenty‐five out of 52 patients experienced ES. We evaluated clinical characteristics, imaging modalities, and electrocardiogram (ECG) parameters to determine the risk factors associated with ES.ResultsHalf of the patients experienced VTAs as the initial symptom of sarcoidosis, and eight patients had ES as the initial VTA episode. There were no differences in cardiac imaging abnormalities between patients with and without ES. Among ECG markers, significant QRS fragmentation (odds ratio [OR]: 7.9, p = .01) and epsilon waves (OR: 12.24, p = .02) were associated with ES. Among the ventricular tachycardia (VT) characteristics, multiple morphologies of monomorphic VTs (OR: 10.9, p < .01), short VT cycle lengths (OR: 12.5, p < .01), and polymorphic VT (OR: 13.5, p < .01) were associated with ES. Bidirectional VTs were detected in 10 patients with ES and one patient without ES. Immunosuppressive therapy relieved ES in some patients.ConclusionsES was common in patients with CS and VTAs. Significant depolarization abnormalities that appeared as QRS fragmentation, epsilon waves, and specific VT characteristics were associated with ES.

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“…Some studies have recently demonstrated that fQRS is linked to myocardial fibrosis and poor prognosis in HF patients [4,5]. The prognostic value of fQRS is not limited to HF and is also observed in other conditions, including coronary artery disease and cardiac sarcoidosis [6,7]. However, some previous research has reported contradictory results regarding the association between fQRS and adverse cardiovascular outcomes in HF patients [8,9].…”

mentioning

confidence: 99%

The prognostic implications of a fragmented QRS pattern in patients diagnosed with heart failure

Demirkıran

Yılmaz²,

Sit

et al. 2023

The European Research Journal

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Objectives: The purpose of this study was to investigate the potential association between the presence of a fragmented QRS (fQRS) pattern on electrocardiogram (ECG) and prognostic outcomes in patients with heart failure (HF). Methods: In the study, 238 patients with a left ventricular ejection fraction of less than 35% were included. The presence of fQRS pattern on ECG was analyzed in all patients. Patients were divided into two groups based on the presence or absence of fQRS on ECG. The primary clinical end points were all-cause mortality and rehospitalization. Results: Baseline demographic characteristics were comparable between the groups. Patients with fQRS had a higher frequency of coronary artery disease and atrial fibrillation (72 (76%) vs 90 (62%), (p = 0.023; 27 (29%) vs 25 (17%), (p = 0.038, respectively). Additionally, patients with fQRS had a higher rate of mortality and rehospitalization during the 5-year follow-up period compared to patients without fQRS. (30 (32%) / 28 (19%), (p = 0.028; 56 (60%) / 50 (35%), p < 0.001, respectively). Multivariable logistic regression analysis revealed that the presence of fQRS was independently associated with mortality and rehospitalization ((p = 0.02 and p < 0.001, respectively). Conclusions: The results of this study suggest that the presence of fQRS on ECG in patients with HF is independently related to a higher risk of mortality and hospitalization. Therefore, the presence of fQRS may be a useful indicator of poor prognosis in these patients.

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Fragmented QRS as a predictor of cardiac events in patients with cardiac sarcoidosis

Cited by 5 publications

References 21 publications

Significant delayed conduction and characteristic ventricular tachycardias in patients with cardiac sarcoidosis and electrical storm

The prognostic implications of a fragmented QRS pattern in patients diagnosed with heart failure

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