Fragmented QRS Predicts Cardiovascular Death of Patients With Structural Heart Disease and Inducible Ventricular Tachyarrhythmia

Hayashi, Takekuni; Fukamizu, Seiji; Hojo, Rintaro; Komiyama, Kanki; Tanabe, Yasuhiro; Tejima, Tamotsu; Nishizaki, Mitsuhiro; Hiraoka, Masayasu; Ako, Junya; Momomura, Shin‐ichi; Sakurada, Harumizu

doi:10.1253/circj.cj-13-0335

Cited by 18 publications

(16 citation statements)

References 30 publications

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“…Sha et al found both narrow f‐QRS and wide f‐QRS predictors of arrhythmic events in patients with idiopathic cardiomyopathy and depressed EF. In patients with ICDs, narrow f‐QRS in a study of Das et al and wide f‐QRS in MADIT II patients were associated with appropriate ICD discharge, but this was not proven by others …”

Section: Discussionmentioning

confidence: 89%

“…Our study showed that heart rate increase exerts a substantial associated with appropriate ICD discharge, but this was not proven by others. 13,14 4.3 | QRS fragmentation to identify patients with impaired-EF VT Most SCD cases have associated coronary artery disease or nonischemic cardiomyopathy, whereby ventricular tachycardia and fibrillation have been reported as the most frequent culprits. 21 Ventricular tachycardia has been early identified as adverse outcome independent predictor of arrhythmic death and total mortality.…”

Section: Qrs Fragmentation To Identify Impaired-ef Vtmentioning

confidence: 99%

“…Fragmentation of the QRS complex (f‐QRS) on the 12‐lead electrocardiogram (ECG), defined as the presence of additional notches buried within the QRS, reflects derangement of ventricular conduction due to myocardial scar or fibrosis . f‐QRS may be associated with prior myocardial infarction, left ventricular dysfunction, and adverse arrhythmic events in various cardiac diseases; however, their utility to risk stratification strategies remains unclear . Addressing as yet unresolved issues in the evaluation of whether and to what extent heart rate change or/and mode of pacing affects the detection of f‐QRS might help to improve SCD risk prediction with the simple, inexpensive and easily available ECG.…”

Section: Introductionmentioning

confidence: 99%

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Effect of heart rate and pacing mode on QRS fragmentation

Zagkli

Despotopoulos

Spiliotopoulos

et al. 2018

Journal of Arrhythmia

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BackgroundThe study was designed to investigate the effect of heart rate and pacing mode on QRS fragmentation (f‐QRS). Moreover, the usefulness of f‐QRS in distinguishing patients with impaired left ventricular ejection function (EF) and ventricular tachycardia (VT) from patients with normal EF was assessed.MethodsThree hundred and six recipients, with dual‐chamber device, with intrinsic narrow or wide QRS complex and preserved atrioventricular conduction were grouped into normal‐EF or impaired‐EF VT. We analyzed intrinsic narrow f‐QRS and wide f‐QRS as well as ventricular‐paced f‐QRS following different heart rates (baseline, 100 bpm) and pacing modes.ResultsIn the baseline state, overall, patients with impaired‐EF VT (35 ± 9%), compared to those with normal‐EF, had more f‐QRS (56% vs 27%, P < .001) and ventricular‐paced f‐QRS (62% vs 16%, P < .0001). Ventricular pacing conferred both at baseline and at higher heart rate more ventricular‐paced f‐QRS in patients with impaired‐EF VT than in normal‐EF (P < .001). Detection of ventricular‐paced f‐QRS markedly improved overall specificity (84%) and positive predictive value (91%) in identifying patients with impaired‐EF VT.ConclusionsIncreased heart rate or/and ventricular pacing uncover QRS fragmentations. Detection of ventricular‐paced f‐QRS adds value toward noninvasive identification of patients with impaired‐EF VT.

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Section: Discussionmentioning

confidence: 89%

Section: Qrs Fragmentation To Identify Impaired-ef Vtmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of heart rate and pacing mode on QRS fragmentation

Zagkli

Despotopoulos

Spiliotopoulos

et al. 2018

Journal of Arrhythmia

View full text Add to dashboard Cite

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“…Previous studies proved that fQRS reflects conduction disturbance [3], and is also associated with myocardial scarring and/or fibrosis [4] which leads to intraventricular systolic dyssynchrony [5]. fQRS was also reported to predict a higher risk of fatal arrhythmic events, including ventricular tachycardia and ventricular fibrillation in patients with cardiac disease, such as MI and structural heart disease [6]. Moreover, Torigoe et al [7 ]found that fQRS increased the risk of cardiac death or hospitalization for heart failure (HF) in patients with prior MI.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Fragmented QRS in Patients with Hypertrophic Cardiomyopathy

Wang

Zhu

et al. 2017

Cardiology

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Objectives: The relationship between a fragmented QRS (fQRS) and clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) remains unclear.This study aimed to investigate the prognostic significance of fQRS in patients with HCM. Methods: Between 2000 and 2012, 326 unrelated patients with HCM (72% male with a mean age of 52 years) were included and were divided into 2 groups: those with fQRS and those without fQRS. Results: A total of 105/326(32.2%) patients with HCM presented with fQRS at enrollment. During a follow-up of 5.3 ± 2.4 years, 33 patients died, 30 of cardiovascular disease (CVD). Cox regression analysis revealed that fQRS predicted a higher risk of all-cause mortality (adjusted hazard ratio [HR] 2.24; 95% confidence interval [CI] 1.08-4.64; p = 0.030) and CVD mortality (adjusted HR 2.68; 95% CI 1.22-5.91; p = 0.014). Our study also showed that fQRS increased the risk of heart failure-related death (adjusted HR 3.75; 95% CI 1.24-11.30; p = 0.019). Conclusions: Our results indicate that fQRS is associated with adverse clinical outcomes in patients with HCM.

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“…So far, numerous noninvasive markers have been introduced for this purpose. 3 Premature ventricular contractions (PVCs), as one among them, occur in 70-95% of patients with HF, in whom they are frequent and complex. 4, 5 Although the effect of PVCs and runs of nonsustained ventricular tachycardia (NSVT) varies with the nature and extent of the underlying disease, their presence in subjects with HF contributes to an increased mortality risk.…”

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confidence: 99%

Increased Variability of the Coupling Interval of Premature Ventricular Contractions as a Predictor of Cardiac Mortality in Patients With Left Ventricular Dysfunction

Lee

Park

Nam

et al. 2015

Circ J

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Background:The characteristics and prognostic value of the variability of premature ventricular contraction (PVC) coupling intervals (CIs) for cardiac mortality are not yet decisive. Methods and Results:In 133 consecutive patients (58±14 years old, 53 women) who had left ventricular dysfunction (LVD: ejection fraction <50%) and frequent PVCs (≥10/h) who underwent 24-h ambulatory electrocardiography (AECG) recording and 123 I-metaiodobenzylguanidine myocardial single-photon emission computed tomography simultaneously, the heart rate turbulence onset, slope, and T-wave alternans were analyzed from the 24-h AECG. The CI of the PVCs (MEANNV), standard deviation of the CI of the PVCs (SDNV) as an index of the variability of the PVC CI, and their ratio to the preceding N-N intervals (SDNV/SDNN) were calculated from constructed Poincaré plots using the annotated 24-h AECG QRS data. The primary endpoint was cardiac mortality. The mean follow-up period was 63 months. Among 133 patients, 114 survived (group 1) and 19 (14%, group 2) died during the follow-up. The MEANNV and SDNV were higher in group 2 (539±104 vs. 599±114 ms, P=0.021; 64±34 vs. 83±37 ms, P=0.022, respectively). The SDNV, PVC count, and delayed heart/mediastinum ratio remained as significant predictors of cardiac mortality in the binary logistic regression analysis. Conclusions:These results suggest that the SDNV could be another adjunctive parameter for predicting cardiac mortality in LVD. (Circ J 2015; 79: 2360 -2366

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Fragmented QRS Predicts Cardiovascular Death of Patients With Structural Heart Disease and Inducible Ventricular Tachyarrhythmia

Cited by 18 publications

References 30 publications

Effect of heart rate and pacing mode on QRS fragmentation

Effect of heart rate and pacing mode on QRS fragmentation

Prognostic Significance of Fragmented QRS in Patients with Hypertrophic Cardiomyopathy

Increased Variability of the Coupling Interval of Premature Ventricular Contractions as a Predictor of Cardiac Mortality in Patients With Left Ventricular Dysfunction

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