Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy

Das, Mithilesh K.; Maskoun, Waddah; Shen, Changyu; Michael, Mark A.; Suradi, Hussam; Desai, Mona; Subbarao, Roopa; Bhakta, Deepak

doi:10.1016/j.hrthm.2009.09.065

Cited by 244 publications

(251 citation statements)

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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

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“…Das et al studied 361 patients in a follow-up period from 6 months to more than 2 years and detected a significant increased risk of arrhythmic events but no effect on mortality [17]. Brenyo et al [35] and Pietrasik et al [34] during (19 ± 12 months) discover no effect in total population; however, increased risk of death only among patients with LBBB and inferior fQRS.…”

Section: Discussionmentioning

confidence: 99%

“…In DCM, fQRS signifies myocardial scar defined by gadolinium delayed enhancement on cardiac magnetic resonance imaging. fQRS also signifies myocardial scar in non-CAD patients [17].…”

Section: Non-coronary Artery Disease (Non-cad)mentioning

confidence: 99%

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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“…Moreover, the only factor associated with the occurrence of malignant ventricular arrhythmia was higher white blood cell count on admission [19]. A similar study of 510 patients who underwent PCI for STEMI indicated that 60% of sustained ventricular arrhythmia occurred during the first 24 h, and 92% during the first 48 h. Independent predictors of sustained ventricular arrhythmia included higher white blood cell count, lower hematocrit and lack of beta-blocker medication [20,21]. Overall, the occurrence of ventricular arrhythmias after AMI was not easy to predict.…”

Section: How To Identify Eligible Patients?mentioning

confidence: 99%

Early Intravenous Beta-blockers for Acute Myocardial Infarction

Guo¹,

He²,

Fu³

2017

J Clin Exp Cardiolog

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Early intravenous beta-blockers reduce the risk of recurrent ischaemia and ventricular arrhythmia in the treatment of acute myocardial infarction. These beneficial efficacy, however, are balanced by a high rate of cardiogenic shock. It has great significance for reliable identification of subgroups of patients among whom treatment is really advantageous. The present article is a review on the efficacy and safety of the early intravenous beta-blockers, and provides an evaluation procedure to guide clinicians applying intravenous beta-blockers to clinical practice.Keywords Beta-blockers; Acute myocardial infarction ReviewBeta-blockers are heralded as a major advance in the treatment of patients with myocardial infarction (MI). Patients without contraindications are recommended to receive intravenous administration of beta-blockers at the time of presentation for relief of ischemic pain; for the control of hypertension, sinus tachycardia and sustained ventricular tachycardia; and for the primary prevention of sudden cardiac death (Class I, Level of Evidence B) [1]. Recent data have called into question the role of beta-blockers in MI. Recommendations on the intravenous administration of beta-blockers by current guidelines are more prudent in these cases (Class IIa, Level of Evidence B) [2,3]. The use of early β-blocker therapy for patients with AMI in China is suboptimal, with underuse in patients who could benefit and substantial use among those who might be harmed [4]. The present article is a review on the efficacy and safeties of the early administration of intravenous beta-blockers examined in trials conducted in the pre-reperfusion era and reperfusion era, and provide an evaluation procedure to guide clinicians applying IV beta-blockers to clinical practice. DeathTwo large trials were conducted in the pre-reperfusion era. In the Metoprolol in Myocardial Infarction (MIAMI) trial, intravenous metoprolol followed by oral administration did not significantly reduce 15-day mortality (4.3% vs. 4.9%, P=0.29) as compared to placebo [5].In another large randomized study, the First International Study of Infarct Survival (ISIS-1) trial, there was significantly lower vascular mortality during the first seven days in the atenolol group (3.89% vs.4.57% , P<0.04) as compared to the placebo group [6]. A meta-analysis of 51 early trials of intravenous beta-blockers, administered at the time of presentation in the pre-reperfusion era, revealed a small and nonsignificant reduction in mortality. The number needed to treat (NNT) was 250 patients to avoid one death [7].Similarly, two large trials were conducted in the reperfusion era. In the Thrombolysis in Myocardial Infarction (TIMI) Phase IIB study, there was no difference in mortality neither within 6 days of entry (2.4% vs. 2.4%, P=0.98) nor within 6 weeks of entry (3.6% vs. 3.5%, P=0.91) between the immediate metoprolol intravenous and deferred groups [8]. The ClOpidogrel and Metoprolol in Myocardial Infarction Trial (COMMIT) were to assess the balance of risks and ...

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Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy

Cited by 244 publications

References 35 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

QRS Fragmentation as a Prognostic Test in Acute Coronary Syndrome

Early Intravenous Beta-blockers for Acute Myocardial Infarction

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