The utility of fragmented QRS complexes to predict significant intraventricular dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval

Tigen, Kürşat; Karaahmet, Tansu; Gürel, Emre; Çevik, Cihan; Nugent, Kenneth; Pala, Selçuk; Tanalp, Ali Cevat; Mutlu, Bülent; Başaran, Yelda

doi:10.1016/s0828-282x(09)70137-0

Cited by 47 publications

(44 citation statements)

References 36 publications

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“…[10] The fQRS was defined as the presence of an additional R wave (R') or notching of R or S wave or the presence of fragmentation (more than one R') in at least two contiguous leads corresponding to a major coronary artery territory. [13] Although Electrocardiographic parameters were compared in patients who were exposed to high voltage (≥ 1000 volts) and low voltage (<1000 volts) subgroups (Table 3) Comparison of the percentage of patients who had abnormal ECG parameters between admission and follow-up ECGs is depicted in Table 4. The percentage of patients who had abnormal PWD, QTc, frontal QRS-T angle, Tp-e interval, Tp-e interval/QT and Tp-e interval/QTc were significantly higher on admission ECGs compared to follow-up ECGs.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Assessment of electrocardiographic parameters in patients with electrocution injury

Karataş

Onuk

Güngör

et al. 2015

Journal of Electrocardiology

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Section: Accepted Manuscriptmentioning

confidence: 99%

Assessment of electrocardiographic parameters in patients with electrocution injury

Karataş

Onuk

Güngör

et al. 2015

Journal of Electrocardiology

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“…Based on this evidence, current class I recommendations were restricted to patients with complete LBBB. However, recent studies showed that fragmented QRS complexes in the electrocardiograms of patients with nonischemic dilated cardiomyopathy and narrow QRS complexes are associated with significant intraventricular dyssynchrony [58,59], and other studies suggested that fragmented QRS complexes might be useful in predicting response to CRT [60,61]. Ongoing studies are investigating the possibility of maximizing CRT benefits by refining ECG selection criteria [62].…”

Section: Patient Selectionmentioning

confidence: 99%

Six Sigma DMAIC for Shaking Stagnant Construction Cultures – A Conceptual Perspective

A¹

2015

J Civ Eng Environ Sci

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Heart Failure is the result of heterogeneous structural heart diseases, especially ischemic disease, and is becoming increasingly common in all Western countries.Many patients continue to be symptomatic in spite of progress in pharmacological therapy, and the risk of mortality remains high in the most advanced functional classes. Cardiac resynchronization therapy can be used as a therapeutic strategy for alleviating symptoms and reducing mortality in selected patients with heart failure.Cardiac resynchronization therapy provides both immediate and medium/long-term results. The immediate results are the reduced QRS duration, the synchrony restoration between the ventricles and between the lateral and septal walls of the left ventricle, the reduced mitral regurgitation and the increased stroke volume. In the medium/long term, left ventricular reverse remodeling occurs and left ventricular ejection fraction is increased.Several trials have documented both increased functional capacity and improvements in quality of life and New York Heart Association class. Moreover, cardiac resynchronization therapy has been seen to reduce HF hospitalizations and mortality and the total number of days of hospitalization.In order to reduce the percentage of non-responders to cardiac resynchronization therapy, it is necessary to optimize the prognostic stratification of candidates for implantation through multi-parameter evaluations and to ensure correct device programming with periodic updates which are widely recommended but not so often performed.Whether indications should be extended will need to be evaluated in view of the known complications mainly associated with lead implantation. RationaleIt is well known that QRS duration is inversely correlated with survival in HF patients in functional classes II-IV, and patients with QRS ≥200 ms have a 5-fold higher risk of death than those with a narrow QRS [7]. In particular, left bundle branch block (LBBB) usually delays activation of the posterior/lateral wall of the left ventricle, leading to asynchronous contraction between the septum and posterior-lateral wall and reducing the left ventricular ejection fraction (LVEF).CRT can correct this asynchronous contraction through the preexcitation of the posterior-lateral wall of the left ventricle, thereby improving systolic function [8,9]. Indeed, the dyssynchrony due to prolonged QRS duration involves the heterogeneous propagation of electrical activity in the ventricle, which determines various degrees of impaired coordination in filling and contraction [10]. Consequently the contractile efficiency of the heart is compromised and the myocardial oxygen consumption increases, worsening the clinical course of HF.

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“…The fQRS was defined as the presence of an additional R wave (R') or notching of R or S wave or the presence of fragmentation (more than one R') in two contiguous leads corresponding to a major coronary artery territory. The fQRS was defined when it was present in at least two contiguous leads of those representing anterior (V 1 to V 5 ), lateral (I, aVL and V 5 , V 6 ), inferior (II, III, aVF), or posterior (V 1 , V 2 ) myocardial segments [5]. The fQRS was seen in more than one myocardial segment in some patients.…”

Section: Electrocardiogrammentioning

confidence: 99%

“…Fragmented QRS (fQRS) complexes are novel electrocardiographic signals which reflect altered ventricular conduction around regions of a myocardial scar. The fQRS is defined as the presence of slurred QRS complexes with various RSR' patterns without typical bundle branch block in two contiguous leads corresponding to a major coronary artery territory [5]. The detection of fQRS complexes in a routine 12-lead ECG is a marker for abnormal cardiac depolarisation.…”

Section: Introductionmentioning

confidence: 99%

The presence of fragmented QRS on 12-lead ECG in patients with coronary slow flow

et al. 2014

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A b s t r a c tBackground: Coronary slow flow (CSF) is characterised by delayed opacification of coronary arteries in the absence of epicardial occlusive disease. It has been reported that CSF may cause angina, myocardial ischaemia, and infarction. Fragmentation of QRS complex (fQRS) is an easily evaluated non-invasive electrocardiographic parameter. It has been associated with alternation of myocardial activation due to myocardial scar and/or ischaemia. Whether CSF is associated with fQRS is unknown. The presence of fQRS on ECG may be an indicator of myocardial damage in patients with CSF. Aim:To investigate the presence of fQRS in patients with CSF.Methods: Sixty patients (mean age 55.5 ± 10.5 years) with CSF and 44 patients with normal coronary arteries without associated CSF (mean age 53 ± 8.4 years) were included in this study. The fQRS was defined as the presence of an additional R wave or notching of R or S wave or the presence of fragmentation in two contiguous leads corresponding to a major coronary artery territory.Results: The presence of fQRS was higher in the CSF group than in the controls (p = 0.005). Hypertension was significantly more common in the CSF group (p < 0.001). There was no significant association between the presence of fQRS and an increasing number of vessel involvements. Logistic regression analysis demonstrated that the presence of CSF was the independent determinant of fQRS (OR = 10.848; 95% CI 2.385-49.347; p = 0.002). Conclusions:Fragmented QRS, indicating increased risk for arrhythmias and cardiovascular mortality, was found to be significantly higher in patients with CSF. We have not found an association between the presence of fragmented QRS and the degree of CSF. Further prospective studies are needed to establish the significance as a possible new risk factor in patients with CSF.

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The utility of fragmented QRS complexes to predict significant intraventricular dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval

Abstract: Fragmentation in the resting ECG is associated with significant intraventricular dyssynchrony in patients with nonischemic cardiomyopathy, narrow QRS and sinus rhythm. Fragmentation in ECG might be useful in identifying patients who could benefit from cardiac resynchronization therapy.

Cited by 47 publications

References 36 publications

Assessment of electrocardiographic parameters in patients with electrocution injury

Assessment of electrocardiographic parameters in patients with electrocution injury

Six Sigma DMAIC for Shaking Stagnant Construction Cultures – A Conceptual Perspective

The presence of fragmented QRS on 12-lead ECG in patients with coronary slow flow

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