Key result
Fragmented QRS links to ~10-fold greater intraventricular dyssynchrony and predicts CRT nonresponse.
Why the study?
Fragmented QRS (fQRS) is postulated to be associated with ventricular dyssynchrony and might predict nonresponse to CRT, but systematic evaluation across ischemic and nonischemic cardiomyopathy was needed.
Does the presence of fragmented QRS predict intraventricular dyssynchrony and nonresponse to cardiac resynchronization therapy in patients with cardiomyopathy?
Meta-Analysis
Does the presence of fragmented QRS predict intraventricular dyssynchrony and nonresponse to cardiac resynchronization therapy in patients with cardiomyopathy?
Odds Ratio: 10.34 (95% CI 3.39–31.54)
p-value: p=<.001
Fragmented QRS on ECG is a significant predictor of intraventricular dyssynchrony and nonresponse to cardiac resynchronization therapy, potentially aiding in patient selection.
fQRS may flag higher CRT nonresponse risk pre-implant; leaves open whether it should guide selection pending prospective trials.
Background Fragmented QRS (fQRS) is postulated to be associated with ventricular dyssynchrony and might be able to predict a nonresponse to cardiac resynchronization therapy (CRT) implantation. In this systematic review and meta‐analysis, we aim to assess whether fQRS can be a marker of intraventricular dyssynchronies in patients with ischemic and nonischemic cardiomyopathy and whether it is an independent predictor of nonresponse in patients receiving CRT. Methods We performed a comprehensive search on topics that assesses fQRS and its association with intraventricular dyssynchrony and nonresponse to CRT up until September 2019. Results Fragmented QRS is associated with intraventricular dyssynchrony (OR 10.34 [3.39, 31.54], p < .001; I2: 80% with sensitivity 76.8%, specificity 77%, LR+ 3.3, and LR− 0.3). Subgroup analysis showed that fQRS is associated with intraventricular dyssynchrony in patients with narrow QRS complex (OR 20.92 [12.24, 35.73], p < .001; I2: 0%) and nonischemic cardiomyopathy (OR of 19.97 [12.12, 32.92], p < .001; I2: 0%). Fragmented QRS was also associated with a higher time‐to‐peak myocardial sustained systolic (Ts‐SD) (OR 15.19 [12.58, 17.80], p < .001; I2: 0% and positive Yu index (OR 15.61 [9.07, 26.86], p < .001; I2: 0%). Fragmented QRS has a pooled adjusted OR of OR of 1.70 [1.35, 2.14], p < .001; I2: 62% for association with a nonresponse to CRT. QRS duration is found to be higher in nonresponders group mean difference −8.54 [−13.38, −3.70], p < .001; I2: 70%. Conclusion Fragmented QRS is associated with intraventricular dyssynchrony and is independently associated with nonresponse to cardiac resynchronization therapy.
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Pranata et al. (2020) conducted a meta-analysis in Ischemic and nonischemic cardiomyopathy. Fragmented QRS was evaluated on Intraventricular dyssynchrony (OR 10.34, 95% CI 3.39-31.54, p=<.001). Fragmented QRS is significantly associated with intraventricular dyssynchrony (OR 10.34; 95% CI 3.39-31.54; P<0.001) and independently predicts nonresponse to cardiac resynchronization therapy.
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