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Heart Rhythm. 2014 Aug;11(8):1433-40. doi: 10.1016/j.hrthm.2014.05.002. Epub 2014 May 6.

Fragmented QRS as a candidate marker for high-risk assessment in hypertrophic cardiomyopathy.

Author information

  • 1Division of Cardiology, Eulji University Hospital, Daejeon, Eulji University College of Medicine, South Korea.
  • 2CardioNXT, Inc., Westminster, Colorado.
  • 3Division of Biostatistics, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
  • 4Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
  • 5Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: hyejin@yuhs.ac.

Abstract

BACKGROUND:

The relationship between a fragmented QRS complex (fQRS) on 12-lead ECG and fatal arrhythmic events in hypertrophic cardiomyopathy (HCM) remains unclear.

OBJECTIVE:

The purpose of this study was to investigate whether fQRS is associated with ventricular arrhythmic events (VAEs) in HCM patients.

METHODS:

Of an initial cohort of 273 patients (57% male, mean age 55 years) diagnosed with HCM, 167 patients were included and divided into 2 groups: those with fQRS (n = 67) and those without fQRS (n = 100). fQRS was defined as notching of the R or S wave in 2 contiguous leads. VAEs were defined as nonsustained or sustained ventricular tachycardia (VT) or sudden cardiac death (SCD). Major arrhythmic events (MAEs) were sustained VT or SCD.

RESULTS:

During mean follow-up of 6.3 years, univariate analysis showed that fQRS was significantly associated with increased VAEs (unadjusted hazard ratio [HR] 6.17, 95% confidence interval [CI] 2.46-15.49, P < .001) and MAEs (unadjusted HR 5.12, 95% CI 1.38-19.01, P = .014). Multivariate analysis revealed that fQRS was a strong independent predictor of VAEs (adjusted HR 6.28, 95% CI 2.49-15.84, P < .001) and MAEs (adjusted HR 6.04, 95% CI 1.49-24.39, P = .011). fQRS in the inferior leads was most closely related to MAEs compared to fQRS in other myocardial territories, and its inclusion in a risk calculator for mortality in HCM patients increased the positive predictive value from 8% to 25% in low-risk patients.

CONCLUSION:

Presence of an fQRS may be a good candidate marker for prediction of VAE in patients with HCM.

Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Fragmented QRS; Hypertrophic cardiomyopathy; Major arrhythmic events; Sudden cardiac death; Ventricular arrhythmic events

PMID:
24813377
[PubMed - in process]
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