Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease

Mithilesh K. Das, Bilal Khan, Sony Jacob, Awaneesh Kumar, Jo Mahenthiran

Research output: Contribution to journalArticle

370 Scopus citations


BACKGROUND - Q waves on a 12-lead ECG are markers of a prior myocardial infarction (MI). However, they may regress or even disappear over time, and there is no specific ECG sign of a non-Q-wave MI. Fragmented QRS complexes (fQRSs), which include various RSR′ patterns, without a typical bundle-branch block are markers of altered ventricular depolarization owing to a prior myocardial scar. We postulated that the presence of an fQRS might improve the ability to detect a prior MI compared with Q waves alone by ECG. METHODS AND RESULTS - A cohort of 479 consecutive patients (mean±SD age, 58.2±13.2 years; 283 males) who were referred for nuclear stress tests was studied. The fQRS included various morphologies of the QRS (<120 ms), which included an additional R wave (R′) or notching in the nadir of the S wave, or >1 R′ (fragmentation) in 2 contiguous leads, corresponding to a major coronary artery territory. The Q wave was present in 71 (14.8%) patients, an fQRS was present in 191 (34.9%) patients, and an fQRS and/or a Q wave was present in 203 (42.3%) patients. Sensitivity, specificity, and the negative predictive value for myocardial scar as detected by single photon emission computed tomography analysis were 36.3%, 99.2%, and 70.8%, respectively, for the Q wave alone; 85.6%, 89%, and 92.7%, respectively, for the fQRS; and 91.4%, 89%, and 94.2%, respectively, for the Q wave and/or fQRS. CONCLUSIONS - The fQRS on a 12-lead ECG is a marker of a prior MI, defined by regional perfusion abnormalities, which has a substantially higher sensitivity and negative predictive value compared with the Q wave.

Original languageEnglish (US)
Pages (from-to)2495-2501
Number of pages7
Issue number21
StatePublished - May 2006


  • Electrocardiography
  • Myocardial infarction
  • Scintigraphy

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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