Key result
Fragmented QRS in inferior ECG leads in patients with a narrow QRS complex was independently associated with a nearly five-fold increased risk of arrhythmic events (OR 4.88).
Why the study?
Patients with ICDs may experience recurrent arrhythmic events, but the predictive value of fragmented QRS as a risk marker in this population has not been established.
Does the presence of fragmented QRS on baseline ECG predict future arrhythmic events in patients with implantable cardioverter-defibrillators?
Cohort (n=367)
No
Does the presence of fragmented QRS on baseline ECG predict future arrhythmic events in patients with implantable cardioverter-defibrillators?
Answers are grounded in this paper and cite their sources.
Fragmented QRS in inferior ECG leads in patients with a narrow QRS complex (<120 ms) is an independent predictor of arrhythmic events in ICD recipients, potentially identifying a high-risk subgroup that may benefit from prophylactic ablation or modified antiarrhythmic therapy.
BACKGROUND: Patients with implantable cardioverter‑defibrillators (ICDs) may experience recurrent arrhythmic events (AE). Identification of these patients may help plan further therapy. Fragmented QRS (fQRS) was identified as a risk marker of AE in various populations but its predictive value in patients with ICD has not been established. AIMS: To examine whether fQRS is a risk marker of future AE in patients with ICD. METHODS: We retrospectively analyzed demographic, clinical, electrocardiographic (ECG), procedural, and follow‑up data of 367 consecutive patients who received ICD in a single tertiary center. A 12‑lead ECG recorded at the time of implantation was analyzed for the presence of fQRS. The analyzed primary endpoint was AE and total mortality was a secondary endpoint. RESULTS: During follow‑up lasting mean (SD) 34.5 (18) months, 146 patients (40%) had AE and total mortality was 18% (67 patients). Univariate analysis identified 7 parameters associated with AE of which 2-ICD implantation for secondary prevention (odds ratio [OR], 2.13; 95% CI, 1.13-4.025; P = 0.02) and fQRS in inferior ECG leads in patients with QRS duration of less than 120 ms (OR, 4.88; 95% CI, 1.18-20; P = 0.03)-remained significant in the multivariable analysis. Total mortality was associated with morbidity but not with fQRS. CONCLUSIONS: Fragmented QRS in inferior ECG leads in patients with QRS duration <120 ms is an independent parameter associated with AE in patients with ICD. Whether it could be helpful in deciding to perform early / prophylactic ablation in these patients needs to be prospectively studied.
No takes yet. Share an insight, caveat, or question.
Kucharz et al. (2020) conducted a cohort in Patients with implantable cardioverter-defibrillators (ICDs) (n=367). Fragmented QRS (fQRS) in inferior ECG leads with narrow QRS vs. Absence of fragmented QRS in inferior leads was evaluated on Arrhythmic events (first appropriate ICD intervention and/or arrhythmic death) (OR 4.88, 95% CI 1.18-20, p=0.03). Fragmented QRS in inferior ECG leads in patients with a narrow QRS complex was independently associated with a nearly five-fold increased risk of arrhythmic events (OR 4.88).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: