Fragmented QRS: a predictor of mortality and sudden cardiac death.

Several invasive and noninvasive tests for risk stratification of sudden cardiac death have been studied, mostly in the context of structural heart disease such as coronary artery disease (CAD), cardiomyopathy, and heart failure. Tests such as MTWA (repolarization abnormality) and SAECG (depolarization abnormality) have high negative predictive values but a low positive predictive value in patients with myocardial infarction or cardiomyopathy. Recently, we described the presence of a fragmented QRS complexes (fQRS) on a routine 12-lead electrocardiogram as another marker of depolarization abnormality. fQRS represents conduction delay caused by myocardial scar in patients with CAD. However, fQRS is not specific for CAD and is also encountered in other myocardial diseases such as cardiomyopathy and congenital heart disease. fQRS is associated with increased mortality and arrhythmic events in patients with CAD. fQRS has also been defined as a marker of arrhythmogenic right ventricular dysplasia/cardiomyopathy and Brugada syndrome. In Brugada syndrome, the presence of fQRS predicts episodes of ventricular fibrillation during follow-up. Therefore, the utility of fQRS in risk stratification of sudden cardiac death needs to be explored further, especially in nonischemic cardiomyopathy and heart failure.

[1]  M. Dunn,et al.  Postinfarction ventricular aneurysms , 1995, Clinical cardiology.

[2]  W. Shimizu,et al.  Electrophysiologic characteristics andimplications of induced ventricular fibrillationin symptomatic patients with brugada syndrome , 2002 .

[3]  J. Spear,et al.  A computer model of the electrogram: what causes fractionation? , 1988, Journal of electrocardiology.

[4]  D. Penney,et al.  Value of notching and slurring of the resting QRS complex in the detection of ischemic heart disease , 1990, Clinical cardiology.

[5]  L. Horan,et al.  Relation of peri-infarction block to ventricular late potentials in patients with inferior wall myocardial infarction. , 1990, The American journal of cardiology.

[6]  L. Horan,et al.  The Anatomic Basis for High‐Frequency Components in the Electrocardiogram , 1969, Circulation.

[7]  Gopi Dandamudi,et al.  Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. , 2007, Heart rhythm.

[8]  W. Shimizu,et al.  Electrophysiologic characteristics and implications of induced ventricular fibrillation in symptomatic patients with Brugada syndrome. , 2002, Journal of the American College of Cardiology.

[9]  H. Morita,et al.  Risk stratification for asymptomatic patients with Brugada syndrome. , 2003, Circulation journal : official journal of the Japanese Circulation Society.

[10]  H. Morita,et al.  Relationships Between Depolarization Abnormality and Repolarization Abnormality in Patients with Brugada Syndrome: , 2004, Journal of cardiovascular electrophysiology.

[11]  Tohru Ohe,et al.  Fragmented QRS as a Marker of Conduction Abnormality and a Predictor of Prognosis of Brugada Syndrome , 2008, Circulation.

[12]  Changyu Shen,et al.  Fragmented Wide QRS on a 12-Lead ECG: A Sign of Myocardial Scar and Poor Prognosis , 2008, Circulation. Arrhythmia and electrophysiology.

[13]  Barry J Maron,et al.  American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death. A scientific statement from the American Heart Association Council on Clinical Cardi , 2008, Journal of the American College of Cardiology.

[14]  H. Wellens,et al.  Sudden cardiac death , 2005 .

[15]  H. Morita,et al.  Epicardial electrogram of the right ventricular outflow tract in patients with the Brugada syndrome: using the epicardial lead. , 2002, Journal of the American College of Cardiology.

[16]  M. Gold,et al.  Sudden cardiac death: the role of risk stratification. , 2007, American heart journal.

[17]  S. Peters,et al.  QRS fragmentation in standard ECG as a diagnostic marker of arrhythmogenic right ventricular dysplasia-cardiomyopathy. , 2008, Heart rhythm.

[18]  I. Wiener,et al.  Fragmented endocardial electrical activity in patients with ventricular tachycardia: a new guide to surgical therapy. , 1982, American heart journal.

[19]  Simona Casini,et al.  Sodium channel dysfunction in inherited and acquired cardiac diseases , 2008 .

[20]  T. D. Schick,et al.  Spectral analysis of the high-frequency electrocardiogram in contusive myocardial injury , 1978, Annals of Biomedical Engineering.

[21]  P. Box.  Are implantable cardioverter defibrillator shocks a surrogate for sudden cardiac death in patients with nonischemic cardiomyopathy , 2006 .

[22]  H. Huikuri,et al.  Sudden death due to cardiac arrhythmias. , 2001, The New England journal of medicine.

[23]  N. Awano,et al.  Detection of abnormal high-frequency components in the QRS complex by the wavelet transform in patients with idiopathic dilated cardiomyopathy. , 1999, Japanese circulation journal.

[24]  Wojciech Zareba,et al.  Prognostic significance of fragmented QRS complex for predicting the risk of recurrent cardiac events in patients with Q-wave myocardial infarction. , 2007, The American journal of cardiology.

[25]  K. Lee,et al.  Prediction of Long-Term Outcomes by Signal-Averaged Electrocardiography in Patients With Unsustained Ventricular Tachycardia, Coronary Artery Disease, and Left Ventricular Dysfunction , 2001, Circulation.

[26]  M. Das,et al.  Significance of a Fragmented QRS Complex Versus a Q Wave in Patients With Coronary Artery Disease , 2006, Circulation.

[27]  D B Geselowitz,et al.  Wide band recording of the electrocardiogram and coronary heart disease. , 1973, American heart journal.

[28]  Toivo Katila,et al.  Increased Intra‐QRS Fragmentation in Magnetocardiography as a Predictor of Arrhythmic Events and Mortality in Patients with Cardiac Dysfunction After Myocardial Infarction , 2006, Journal of cardiovascular electrophysiology.

[29]  P. Varriale,et al.  The RSR' complex not related to right bundle branch block: diagnostic value as a sign of myocardial infarction scar. , 1992, American heart journal.

[30]  P. Ursell,et al.  Electrophysiologic and anatomic basis for fractionated electrograms recorded from healed myocardial infarcts. , 1985, Circulation.

[31]  Mark E. Josephson,et al.  Prediction of Long-Term Outcomes by Signal-Averaged Electrocardiography in Patients With Unsustained Ventricular Tachycardia, Coronary Artery Disease, and Left Ventricular Dysfunction , 2002 .

[32]  S. Priori,et al.  Cardiac Histological Substrate in Patients With Clinical Phenotype of Brugada Syndrome , 2005, Circulation.