Fragmented QRS complex as a predictor of in-hospital life-threatening arrhythmias in myocardial infarction patients: A systematic review and meta-analysis

BACKGROUND: Ventricular arrhythmia is an important cause of death in myocardial infarction (MI). Fragmented QRS (fQRS) is an ECG pattern reflecting the inhomogeneity of ventricular conduction and has been demonstrated to be a predictor of arrhythmia in several cardiac conditions. This study aimed to evaluate the prognostic impact of fQRS on arrhythmias in MI patients. METHODS: A systematic search was conducted using 4 databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, from inception to July 20, 2024. The inclusion criteria were studies that included MI patients and compared the rate of in-hospital arrhythmia between fQRS and non-fQRS participants. RESULTS: A total of 14 studies were included in this meta-analysis, involving 4566 participants. The presence of fQRS was associated with a higher incidence of ventricular tachycardia (VT) and ventricular fibrillation (VF) compared to non-fQRS, with an odds ratio (OR) of 2.96 (95 %CI 2.00 to 4.39), p < 0.01. Similarly, fQRS was associated with a higher risk of VT, with an OR of 3.59 (95 %CI 1.66 to 7.80), p < 0.01. Although the presence of fQRS did not significantly increase the risk of VF compared to non-fQRS, a sensitivity analysis that excluded a study with serious risk of bias showed that the presence of fQRS was associated with an increased risk of VF, with an OR of 2.45 (95 %CI 1.38 to 4.35), p < 0.01. CONCLUSIONS: The presence of fQRS was associated with a higher risk of in-hospital arrhythmia in MI patients. The fQRS is a potential tool for risk stratification in MI patients for arrhythmia.