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

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

Research output: Contribution to journalArticle

158 Citations (Scopus)

Abstract

Background: Myocardial scar is a substrate for reentrant ventricular arrhythmias and is associated with poor prognosis. Fragmented QRS (fQRS) on 12-lead ECG represents myocardial conduction delays due to myocardial scar in patients with coronary artery disease (CAD). Objective: The purpose of this study was to determine whether fQRS is associated with increased ventricular arrhythmic event and mortality in patients with CAD and nonischemic dilated cardiomyopathy (DCM). Methods: Arrhythmic events and mortality were studied in 361 patients (91% male, age 63.3 ± 11.4 years, mean follow-up 16.6 ± 10.2 months) with CAD and DCM who received an implantable cardioverter-defibrillator for primary or secondary prophylaxis. fQRS included various RSR′ patterns (QRS duration <120 ms), such as ≥1 R prime or notching of the R wave or S wave present on at least two contiguous leads of those representing anterior (V1-V5), lateral (I, aVL, V6), or inferior (II, III, aVF) myocardial segments. Results: fQRS was present in 84 (23%) patients (fQRS group) and absent in 100 (28%) patients (non-fQRS group). Wide QRS (wQRS; QRS duration ≥120 ms) was present in 177 (49%) patients. Kaplan-Meier analysis revealed that event-free survival for an arrhythmic event (implantable cardioverter-defibrillator shock or antitachycardia pacing) was significantly lower in the fQRS group than in the non-fQRS and wQRS groups (P <.001 and P <.019, respectively). fQRS was an independent predictor of an arrhythmic event but not of death. Conclusion: fQRS on 12-lead ECG is a predictor of arrhythmic events in patients with CAD and DCM. fQRS is associated with a significantly decreased time to first arrhythmic event compared with non-fQRS and wQRS.

Original languageEnglish
Pages (from-to)74-80
Number of pages7
JournalHeart Rhythm
Volume7
Issue number1
DOIs
StatePublished - Jan 2010

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Cardiomyopathies
Electrocardiography
Coronary Artery Disease
Dilated Cardiomyopathy
Implantable Defibrillators
Cicatrix
Mortality
Kaplan-Meier Estimate
Lead
Disease-Free Survival
Cardiac Arrhythmias
Shock

Keywords

  • Arrhythmic event
  • Fragmented QRS
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. / Das, Mithilesh; Maskoun, Waddah; Shen, Changyu; Michael, Mark A.; Suradi, Hussam; Desai, Mona; Subbarao, Roopa; Bhakta, Deepak.

In: Heart Rhythm, Vol. 7, No. 1, 01.2010, p. 74-80.

Research output: Contribution to journalArticle

Das, Mithilesh ; Maskoun, Waddah ; Shen, Changyu ; Michael, Mark A. ; Suradi, Hussam ; Desai, Mona ; Subbarao, Roopa ; Bhakta, Deepak. / Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. In: Heart Rhythm. 2010 ; Vol. 7, No. 1. pp. 74-80.
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T1 - Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy

AU - Das, Mithilesh

AU - Maskoun, Waddah

AU - Shen, Changyu

AU - Michael, Mark A.

AU - Suradi, Hussam

AU - Desai, Mona

AU - Subbarao, Roopa

AU - Bhakta, Deepak

PY - 2010/1

Y1 - 2010/1

N2 - Background: Myocardial scar is a substrate for reentrant ventricular arrhythmias and is associated with poor prognosis. Fragmented QRS (fQRS) on 12-lead ECG represents myocardial conduction delays due to myocardial scar in patients with coronary artery disease (CAD). Objective: The purpose of this study was to determine whether fQRS is associated with increased ventricular arrhythmic event and mortality in patients with CAD and nonischemic dilated cardiomyopathy (DCM). Methods: Arrhythmic events and mortality were studied in 361 patients (91% male, age 63.3 ± 11.4 years, mean follow-up 16.6 ± 10.2 months) with CAD and DCM who received an implantable cardioverter-defibrillator for primary or secondary prophylaxis. fQRS included various RSR′ patterns (QRS duration <120 ms), such as ≥1 R prime or notching of the R wave or S wave present on at least two contiguous leads of those representing anterior (V1-V5), lateral (I, aVL, V6), or inferior (II, III, aVF) myocardial segments. Results: fQRS was present in 84 (23%) patients (fQRS group) and absent in 100 (28%) patients (non-fQRS group). Wide QRS (wQRS; QRS duration ≥120 ms) was present in 177 (49%) patients. Kaplan-Meier analysis revealed that event-free survival for an arrhythmic event (implantable cardioverter-defibrillator shock or antitachycardia pacing) was significantly lower in the fQRS group than in the non-fQRS and wQRS groups (P <.001 and P <.019, respectively). fQRS was an independent predictor of an arrhythmic event but not of death. Conclusion: fQRS on 12-lead ECG is a predictor of arrhythmic events in patients with CAD and DCM. fQRS is associated with a significantly decreased time to first arrhythmic event compared with non-fQRS and wQRS.

AB - Background: Myocardial scar is a substrate for reentrant ventricular arrhythmias and is associated with poor prognosis. Fragmented QRS (fQRS) on 12-lead ECG represents myocardial conduction delays due to myocardial scar in patients with coronary artery disease (CAD). Objective: The purpose of this study was to determine whether fQRS is associated with increased ventricular arrhythmic event and mortality in patients with CAD and nonischemic dilated cardiomyopathy (DCM). Methods: Arrhythmic events and mortality were studied in 361 patients (91% male, age 63.3 ± 11.4 years, mean follow-up 16.6 ± 10.2 months) with CAD and DCM who received an implantable cardioverter-defibrillator for primary or secondary prophylaxis. fQRS included various RSR′ patterns (QRS duration <120 ms), such as ≥1 R prime or notching of the R wave or S wave present on at least two contiguous leads of those representing anterior (V1-V5), lateral (I, aVL, V6), or inferior (II, III, aVF) myocardial segments. Results: fQRS was present in 84 (23%) patients (fQRS group) and absent in 100 (28%) patients (non-fQRS group). Wide QRS (wQRS; QRS duration ≥120 ms) was present in 177 (49%) patients. Kaplan-Meier analysis revealed that event-free survival for an arrhythmic event (implantable cardioverter-defibrillator shock or antitachycardia pacing) was significantly lower in the fQRS group than in the non-fQRS and wQRS groups (P <.001 and P <.019, respectively). fQRS was an independent predictor of an arrhythmic event but not of death. Conclusion: fQRS on 12-lead ECG is a predictor of arrhythmic events in patients with CAD and DCM. fQRS is associated with a significantly decreased time to first arrhythmic event compared with non-fQRS and wQRS.

KW - Arrhythmic event

KW - Fragmented QRS

KW - Mortality

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