Fragmented QRS is associated with ventricular arrhythmias in heart failure patients: A systematic review and meta‐analysis

Engstrom, Nathan; Dobson, Geoffrey P.; Ng, Kevin; Letson, Hayley L.

doi:10.1111/anec.12910

Cited by 11 publications

(21 citation statements)

References 36 publications

(137 reference statements)

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“…In addition, increased myocardial fibrosis not only results in conduction abnormalities, but also LV systolic dysfunction and heart failure ( 29 , 30 ). Hence, it is not surprising that f-QRS showed a negative relationship with LVEF% in our DD group.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Fragmented QRS Complex and Left Ventricular Fibrosis and Function in Patients With Danon Disease

Xie

Liu

Wei

et al. 2022

Front. Cardiovasc. Med.

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BackgroundFragmented QRS (f-QRS) complex on the surface ECG is a cardiac conduction abnormality that indicates myocardial scarring. The relationship between the f-QRS complex and cardiac status in patients with Danon disease (DD) remains unclear and will be explored in this study.MethodsPatients with genetically confirmed DD and cardiac magnetic resonance imaging (CMR) examinations were recruited from multiple centers. The number of leads, pattern, score, and segmental distribution of the f-QRS complex were assessed by surface 12-lead ECG. Cardiac status, such as left ventricular (LV) volume, function, and extent of late gadolinium enhancement (LGE), was demonstrated by CMR. The segmental distribution of LGE was also assessed. Correlations between the f-QRS and cardiac status were assessed.ResultsFifteen patients (14 men) with DD who underwent 12-lead ECG and CMR imaging were included. The f-QRS complex was documented in all patients (n = 15, 100%). Three patterns of f-QRS were found, with the notched R/S pattern (74%) being the most common, followed by fragmented QRS (16%) and various RSR' (11%). The fragmented QRS pattern showed an association with a higher level of myocardial fibrosis (LGE > 35%). The burden of f-QRS in each patient was assessed by the number of leads with f-QRS (median 7, range 2–12) and the f-QRS score (median 9, range 2–33). In the correlation analysis, the f-QRS score was positively correlated with LGE% (r = 0.726, p = 0.002), negatively correlated with LV ejection function (LVEF; r = −0.617, p = 0.014) as evaluated by CMR. In the local distribution, f-QRS score and LGE% were both predominant in the LV free wall but did not correlate well among the anterior, lateral, and inferior segments.ConclusionIn this DD cohort, the quantitative f-QRS was correlated well with myocardial fibrosis burden and LV dysfunction in general. This finding suggests that f-QRS can be used as a simple screening tool to assess cardiac status in patients with DD.

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Section: Discussionmentioning

confidence: 99%

Relationship Between Fragmented QRS Complex and Left Ventricular Fibrosis and Function in Patients With Danon Disease

Xie

Liu

Wei

et al. 2022

Front. Cardiovasc. Med.

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“…We recently performed a systematic review and meta-analysis of studies examining fQRS in patients with HF with or without an ICD, and with LVEF ≤40%. 13 Outcome measures were ventricular arrhythmias and all-cause mortality. 13 Using these search criteria, we analysed 10 studies involving 3885 patients and found that fQRS was statistically associated with ventricular arrhythmias and all-cause mortality.…”

Section: Introductionmentioning

confidence: 99%

“… 13 Outcome measures were ventricular arrhythmias and all-cause mortality. 13 Using these search criteria, we analysed 10 studies involving 3885 patients and found that fQRS was statistically associated with ventricular arrhythmias and all-cause mortality. Furthermore, our study revealed a number of knowledge gaps in current reporting.…”

Section: Introductionmentioning

confidence: 99%

“… 13 A further complication was the failure to separate primary and secondary prevention patients with HF as well as those with ischaemic (ICM) vs non-ICM (NICM) cardiomyopathies. 13 There were also concerns on the reproducibility of ECG measurements, fQRS characterisation, counting of leads and intra and interobserver variability. 14 Miscounting leads and subjective visual yes/no diagnoses can make some studies inaccurate and non-reproducible.…”

Section: Introductionmentioning

confidence: 99%

“… 5 Diffuse fibrosis also appears to be more strongly associated with arrhythmias than scar tissue secondary to myocardial infarction and may help explain why patients with NICM with fQRS have a significant 2-fold to 3-fold increased incidence of death compared with patients with ICM. 13 The sensitivity and specificity of fQRS to predict a scar in patients with ICM or NICM is around 80–90% using SPECT, MCG or Ga-MRI, 5 7 12 15 and future studies could benefit from including these quantitative assessments.…”

Section: Introductionmentioning

confidence: 99%

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Predicting arrhythmias in primary prevention heart failure patients: picking up the fragments

Engstrom

Letson

et al. 2022

Open Heart

Self Cite

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Identifying patients with high-risk heart failure (HF) who would benefit from an implantable cardioverter-defibrillator (ICD) remains controversial. A potential marker for arrhythmic sudden death is fragmented QRS (fQRS). fQRS is the notching and slurring of the QRS complex in a 12-lead ECG and it indicates abnormal ventricular depolarisation and myocardial scarring and fibrosis. However, before fQRS complex can be included into selection criteria for ICD therapy, more complete reporting is required on their association with malignant arrhythmias, left ventricular remodelling and myocardial scarring/fibrosis in patients with HF. The molecular basis of the fQRS-arrhythmia-fibrosis connection in HF also needs to be explored. It is not widely appreciated that changes in the QRS complex and phases 0 and 1 of the ventricular action potential occur before contraction and predetermine Ca2+ release during contraction and later Ca2+ sparks. It is currently not known whether the different zig-zag patterns of the QRS are associated with aberrant Ca2+ cycling and arrhythmogenic sparks in patients with HF.

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QRS fragmentation does not predict mortality in survivors of acute myocardial infarction

Allescher,

Sinnecker,

von Goeldel

et al. 2024

Clinical Cardiology

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BackgroundDespite advances in coronary revascularization and in heart failure management, myocardial infarction survivors remain at substantially increased mortality risk. Precise risk assessment and risk‐adapted follow‐up care are crucial to improve their outcomes. Recently, the fragmented QRS complex, i.e. the presence of additional spikes within the QRS complexes on a 12‐lead electrocardiogram, has been discussed as a potential non‐invasive risk predictor in cardiac patients.HypothesisThe aim of this study was to evaluate the prognostic meaning of the fragmented QRS complex in myocardial infarction survivors.Methods609 patients with narrow QRS complexes <120 ms were included in a prospective cohort study while hospitalized for myocardial infarction and followed for 5 years.ResultsThe prevalence of the fragmented QRS complex in these patients amounted to 46.8% (285 patients). These patients had no increased hazard of all‐cause death (HR 0.84, 95%–CI 0.45–1.57, p = 0.582) with a mortality rate of 6.0% compared to 7.1% in patients without QRS fragmentations. Furthermore, the risks of cardiac death (HR 1.28, 95%–CI 0.49–3.31, p = 0.613) and of non‐cardiac death (HR 0.6, 95%–CI 0.26–1.43, p = 0.25) were not significantly different in patients with QRS fragmentations. However, patients with QRS fragmentations had increased serum creatine kinase concentrations (1438U/l vs. 1160U/l, p = 0.039) and reduced left ventricular ejection fractions (52% vs. 54%, p = 0.011).ConclusionsThe hypothesis that QRS fragmentation might be a prognostic parameter in survivors of myocardial infarction was not confirmed. But those with QRS fragmentation had larger myocardial infarctions, as measured by creatine kinase and left ventricular ejection fraction.

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Fragmented QRS is associated with ventricular arrhythmias in heart failure patients: A systematic review and meta‐analysis

Cited by 11 publications

References 36 publications

Relationship Between Fragmented QRS Complex and Left Ventricular Fibrosis and Function in Patients With Danon Disease

Relationship Between Fragmented QRS Complex and Left Ventricular Fibrosis and Function in Patients With Danon Disease

Predicting arrhythmias in primary prevention heart failure patients: picking up the fragments

QRS fragmentation does not predict mortality in survivors of acute myocardial infarction

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