The extent of QRS fragmentation was superior to QRS duration in predicting all-cause mortality in adults with tetralogy of Fallot (HR 2.24/class; 95% CI 1.48-3.40; p<0.001).
Cohort (n=794)
Yes
Does the extent of QRS fragmentation predict mortality and ventricular arrhythmias better than QRS duration in adults with tetralogy of Fallot?
The extent of QRS fragmentation on a standard 12-lead ECG is superior to QRS duration for predicting long-term mortality and ventricular arrhythmias in adults with tetralogy of Fallot.
Effect estimate: HR 2.24/class (95% CI 1.48-3.40)
p-value: p=<0.001
BACKGROUND: Although QRS duration >180 ms has prognostic value in adults with tetralogy of Fallot (TOF), its sensitivity to predict mortality is low. Fragmented QRS complexes, a simple measurement on ECG, are related to myocardial fibrosis and dysfunction in patients with TOF. Our objective was to determine whether QRS fragmentation predicts major outcomes in TOF. METHODS: This multicentre study included adult patients with TOF from a prospective registry. Notches in the QRS complex in ≥2 contiguous leads on a 12-lead ECG, not related to bundle branch block, were defined as QRS fragmentation, which was classified as none, moderate (≤4 leads) or severe (≥5 leads). The primary and secondary outcomes were all-cause mortality and clinical ventricular arrhythmia, respectively. RESULTS: A total of 794 adult patients with TOF (median age 27 years, 55% male; 52% no QRS fragmentation, 32% moderate, 16% severe) were included. During long-term (median 10.4 years) follow-up, 46 (6%) patients died and 35 (4%) patients had ventricular arrhythmias. Overall, 10-year survival was 98% in patients without fragmented QRS complexes, 93% in patients with moderate QRS fragmentation and 81% in patients with severe QRS fragmentation. In multivariable Cox hazards regression analysis, extent of QRS fragmentation (HR: 2.24/class, 95% CI 1.48 to 3.40, p<0.001) remained independently predictive for mortality, whereas QRS duration was not predictive (p=0.85). The extent of QRS fragmentation was also independently predictive for ventricular arrhythmia (HR: 2.00/class, 95% CI 1.26 to 3.16, p=0.003). CONCLUSIONS: The extent of QRS fragmentation is superior to QRS duration in predicting mortality in adult patients with TOF and may be used in risk stratification.
Bokma et al. (Tue,) conducted a cohort in Tetralogy of Fallot (n=794). QRS fragmentation vs. QRS duration was evaluated on All-cause mortality (HR 2.24/class, 95% CI 1.48-3.40, p=<0.001). The extent of QRS fragmentation was superior to QRS duration in predicting all-cause mortality in adults with tetralogy of Fallot (HR 2.24/class; 95% CI 1.48-3.40; p<0.001).