Key result
fQRS in elite cyclists is linked to physiological LV and RV adaptation without requiring further testing.
Why the study?
The relationship between electrocardiographic QRS fragmentation and physiological cardiac adaptation in elite athletes is not fully understood.
Is fragmented QRS on the 12-lead ECG associated with physiological cardiac adaptation in elite cyclists?
Cross-Sectional (n=181)
Is fragmented QRS on the 12-lead ECG associated with physiological cardiac adaptation in elite cyclists?
Fragmented QRS is common in elite cyclists (41%) and is associated with physiological left and right ventricular adaptation, suggesting it may not require further investigation in isolation.
May reassure against routine further testing for isolated fQRS in elite cyclists; leaves open need for longitudinal outcome studies.
Background The relationship between electrocardiographic based QRS fragmentation (fQRS) and physiological cardiac adaptation is not fully understood. We aimed to determine the prevalence of fQRS in elite male and female cyclists, and relationship between fQRS and cardiac structure and function. Methods 181 Elite international cyclists underwent their national cycling team's pre-participation cardiac screening. This included a resting 12‑lead electrocardiogram and transthoracic echocardiogram. Fragmented QRS was defined as an additional notch >1 mm deep from the peak of the wave within the QRS complex in any lead. We excluded RSR' or RSR'S′ patterns in V1–2 to differentiate from bundle branch block. Results Fragmented QRS was observed in 73 (41 %) of the cyclists. The most common lead was V1, followed by lead III, aVL and aVF. Of those cyclists with fQRS it was observed in just one lead in 38 cyclists (52 %), two leads in 22 cyclists (30 %) and ≥ three leads in 13 cyclists (18 %). Cyclists with fQRS demonstrated greater left ventricular (LV) diastolic diameter index ( p = 0.008), mean wall thickness ( p < 0.001), LV mass index ( p = 0.001), proximal right ventricular (RV) outflow diameter (RVOT PLAX ) index ( p = 0.040), distal RVOT 2 index (p < 0.001), RV systolic area index ( p = 0.005), and RV:LV ratio ( p = 0.008). In addition, cyclists with fQRS had significantly lower RV fractional area change ( p = 0.002). Conclusion Fragmented QRS in athletes is associated with indices of physiological LV and RV adaptation. In isolation, fQRS may not raise concern or initiate any further onward investigations.
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Goodman et al. (2026) conducted a cross-sectional in Physiological cardiac adaptation in elite athletes (n=181). Fragmented QRS (fQRS) vs. Absence of fragmented QRS was evaluated on Prevalence of fragmented QRS and association with cardiac structure and function. Fragmented QRS was present in 41% of elite cyclists and was significantly associated with indices of physiological left and right ventricular adaptation.
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