Download Prognostic value of QRS fragmentation in patients with

Prognostic value of QRS
fragmentation in patients with
arrhythmogenic right ventricular
cardiomyopathy
S.Peters, M.Trümmel, B.Koehler
St.Antonius-Hospital Gronau
Klinikum D.Ch.Erxleben
Quedlinburg
No conflicts of interest to
declare
QRS fragmentation as a diagnostic
marker of ARVC/D

Peters S, Trümmel M, Koehler B. QRS
fragmentation in standard ECG as a
diagnostic marker of arrhythmogenic right
ventricular dysplasia-cardiomyopathy.Heart
Rhythm. 2008 Oct;5(10):1417-21

Das MK, Zipes DP. Fragmented QRS: a
predictor of mortality and sudden cardiac
death.Heart Rhythm. 2009 Mar;6(3 Suppl):S814
if: CAD and Brugada syndrome excluded
Forms of QRS fragmentation
Epsilon wave or prolonged S wave upstroke
Prolonged S wave or terminal activation delay
METHOD
305 patients (167 males) with ARVC/D
according to Task Force Criteria after
exclusion of 22 patients with RBBB und
47 patients with iRBBB
Mean age 46.3 ± 14.6 years
QRS fragmentation in 83% of patients
2.09 ± 1.8 leads involved (range 1-7)
Value of QRS fragmentation of the S
wave in right precordial leads
in patients with recurrent VT:
n=23/39
p < 0.01
in patients with primary ventricular fibrillation
n=22/32
p < 0.0001
in patients with recurrent ICD discharges
n=20/30
p < 0.001
QRS fragmentation in the S wave in right
precordial leads
Sensitivity and specificity:
59 and 69%, 64 and 68%
Negative predictive value:
Recurrent VT = 91%
Primary ventricular fibrillation = 95%
Recurrent ICD discharges = 92%
QRS fragmentation in ≥ 3 leads
in patients with sudden cardiac death
n= 5/7
p < 0.0000001
Sensitivity = 71%
Specificity = 100%
Positive predictive value = 100%
Negative predictive value = 97%
QRS fragmentation ≥ 3 in ARVD/C
Kaplan-Meier curve ± QRS
fragmentation
Without QRS fragmentation
(17%)
p < 0.045
With QRS fragmentation
(83%)
3 mo.
No. at risk
6 mo.
9 mo.
10
11
16
24
22
23
Conclusions
QRS fragmentation predicts arrhythmic
event rate and sudden cardiac death. QRS
fragmentation of the S wave in leads V1 to
V3 is a valuable finding with increased risk
of recurrent ventricular tachycardia, primary
ventricular fibrillation and recurrent ICD
discharges. A number of  3 leads with QRS
fragmentation identifies patients who died
from sudden cardiac death although the
number of patients with sudden cardiac
death are relatively low.