Heart Rhythm
Volume 6, Issue 3, Supplement , Pages S8-S14 , March 2009

Fragmented QRS: A predictor of mortality and sudden cardiac death

  • Mithilesh K. Das, MD

      Affiliations

    • Corresponding Author InformationAddress reprint requests and correspondence: Dr. Mithilesh Kumar Das, Krannert Institute of Cardiology, Roudebush VA Medical Center, Indiana University School of Medicine, 1800 North Capitol Avenue, Indianapolis, Indiana 46202
    • ,
  • Douglas P. Zipes, MD, FHRS

      Affiliations

    • This manuscript was independently reviewed.

References 

  1. Zipes DP, Wellens HJ. Sudden cardiac death. Circulation. 1998;98:2334–2351
  2. Huikuri HV, Castellanos A, Myerburg RJ. Sudden death due to cardiac arrhythmias. N Engl J Med. 2001;345:1473–1482
  3. Das MK, Khan B, Jacob S, et al. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation. 2006;113:2495–2501
  4. Peters S, Trümmel M, Koehler B. QRS fragmentation in standard ECG as a diagnostic marker of arrhythmogenic right ventricular dysplasia-cardiomyopathy. Heart Rhythm. 2008;5:1417–1421
  5. Morita H, Fukushima K, Miura D, et al. Fragmented QRS as a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome. Circulation. 2008;118:1697–1704
  6. Das M, Suradi H, Maskoun W, et al. Fragmented wide QRS on a 12-lead ECG: A Sign of Myocardial Scar and Poor Prognosis. Circ Arrhythmia Electrophysiol. 2008;1:258–268
  7. Das MK, Saha C, El Masry H, et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm. 2007;4:1385–1392
  8. Maskoun W, Suradi H, Mahenthiran J, et al. Fragmented QRS complexes on a 12-lead ECG predict arrhythmic events in patients with ischemic cardiomyopathy who receive an ICD for primary prophylaxis. Heart Rhythm. 2007;4:S211–S212
  9. Pietrasik G, Goldenberg I, Zdzienicka J, et al. Prognostic significance of fragmented QRS complex for predicting the risk of recurrent cardiac events in patients with Q-wave myocardial infarction. Am J Cardiol. 2007;100:583–586
  10. Maehara K, Kokubun T, Awano N, et al. Detection of abnormal high-frequency components in the QRS complex by the wavelet transform in patients with idiopathic dilated cardiomyopathy. Jpn Circ J. 1999;63:25–32
  11. Michael M, Das M. Fragmented QRS (fQRS) on 12-lead EKG is a predictor of arrhythmic events and mortality in patients with dilated cardiomyopathy. Heart Rhythm. 2006;3(Suppl):S103
  12. Ellenbogen KA, Levine JH, Berger RD, et al. Are implantable cardioverter defibrillator shocks a surrogate for sudden cardiac death in patients with nonischemic cardiomyopathy?. Circulation. 2006;113:776–782
  13. Kanda M, Shimizu W, Matsuo K, et al. Electrophysiologic characteristics and implications of induced ventricular fibrillation in symptomatic patients with Brugada syndrome. J Am Coll Cardiol. 2002;39:1799–1805
  14. Hisamatsu K, Kusano KF, Morita H, et al. Relationships between depolarization abnormality and repolarization abnormality in patients with Brugada syndrome: using body surface signal-averaged electrocardiography and body surface maps. J Cardiovasc Electrophysiol. 2004;15:870–876
  15. Morita H, Takenaka-Morita S, Fukushima-Kusano K, et al. Risk stratification for asymptomatic patients with Brugada syndrome. Circ J. 2003;67:312–316
  16. Nagase S, Kusano KF, Morita H, et al. Epicardial electrogram of the right ventricular outflow tract in patients with the Brugada syndrome: using the epicardial lead. J Am Coll Cardiol. 2002;39:1992–1995
  17. Postema P, Tan H, Dekker L, et al. Right ventricular endocardial mapping in Brugada syndrome patients reveals cooperative depolarization and repolarization abnormalities. Circulation. 2007;116:II490–II491
  18. Wiener I, Mindich B, Pitchon R. Fragmented endocardial electrical activity in patients with ventricular tachycardia: a new guide to surgical therapy. Am Heart J. 1984;107:86–90
  19. Kusmirek SL, Gold MR. Sudden cardiac death: the role of risk stratification. Am Heart J. 2007;153(Suppl):25–33
  20. Goldberger JJ, Cain ME, Hohnloser SH, 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 Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention. Circulation. 2008;118:1497–1518
  21. Gomes JA, Cain ME, Buxton AE, et al. Prediction of long-term outcomes by signal-averaged electrocardiography in patients with unsustained ventricular tachycardia, coronary artery disease, and left ventricular dysfunction. Circulation. 2001;104:436–441
  22. Korhonen P, Husa T, Tierala I, et al. Increased intra-QRS fragmentation in magnetocardiography as a predictor of arrhythmic events and mortality in patients with cardiac dysfunction after myocardial infarction. J Cardiovasc Electrophysiol. 2006;17:396–401
  23. Flowers NC, Horan LG, Thomas JR, et al. The anatomic basis for high-frequency components in the electrocardiogram. Circulation. 1969;39:531–539
  24. Flowers NC, Horan LG, Wylds AC, et al. Relation of peri-infarction block to ventricular late potentials in patients with inferior wall myocardial infarction. Am J Cardiol. 1990;66:568–574
  25. Varriale P, Chryssos BE. The RSR′ complex not related to right bundle branch block: diagnostic value as a sign of myocardial infarction scar. Am Heart J. 1992;123:369–376
  26. France RJ, Formolo JM, Penney DG. Value of notching and slurring of the resting QRS complex in the detection of ischemic heart disease. Clin Cardiol. 1990;13:190–196
  27. Lesh MD, Spear JF, Simson MB. A computer model of the electrogram: what causes fractionation?. J Electrocardiol. 1988;21(Suppl):S69–S73
  28. Schick TD, Powers SR. Spectral analysis of the high-frequency electrocardiogram in contusive myocardial injury. Ann Biomed Eng. 1978;6:154–160
  29. Langner PH, Geselowitz DB, Briller SA. Wide band recording of the electrocardiogram and coronary heart disease. Am Heart J. 1973;86:308–317
  30. Gardner PI, Ursell PC, Fenoglio JJ, et al. Electrophysiologic and anatomic basis for fractionated electrograms recorded from healed myocardial infarcts. Circulation. 1985;72:596–611
  31. Friedman BM, Dunn MI. Postinfarction ventricular aneurysms. Clin Cardiol. 1995;18:505–511
  32. Morita H. Fukushima K, Miura D, et al. Fragmented QRS as a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome. Circulation (in press).
  33. Coronel R, Casini S, Koopmann TT, et al. Right ventricular fibrosis and conduction delay in a patient with clinical signs of Brugada syndrome: a combined electrophysiological, genetic, histopathologic, and computational study. Circulation. 2005;112:2769–2777
  34. Frustaci A, Priori SG, Pieroni M, et al. Cardiac histological substrate in patients with clinical phenotype of Brugada syndrome. Circulation. 2005;112:3680–3687

 Dr Zipes is a consultant to Medtronic, Inc.

 Dr Das has no conflict of interest.

PII: S1547-5271(08)01015-1

doi: 10.1016/j.hrthm.2008.10.019

Heart Rhythm
Volume 6, Issue 3, Supplement , Pages S8-S14 , March 2009

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