The fragmented QRS: does it really indicate a ventricular abnormality?

Area of Science:

• Cardiology
• Electrocardiography
• Cardiac Imaging

Background:

• Notching in QRS waves can indicate myocardial infarction.
• Fragmented QRS (fQRS) demonstrates high sensitivity and specificity for myocardial scar in ischemic heart disease.
• The clinical significance of fQRS in broader patient populations requires further investigation.

Purpose of the Study:

• To determine the significance of fragmented QRS (fQRS) in electrocardiograms.
• To assess fQRS in patients undergoing various myocardial imaging techniques.
• To evaluate the association of fQRS with ventricular abnormalities.

Main Methods:

• Electrocardiograms were analyzed to identify patients with fQRS and without abnormal Q waves.
• Patients underwent myocardial perfusion scanning, echocardiography, or cardiac magnetic resonance imaging.
• Control groups included patients without fQRS and those with or without fQRS undergoing MRI with late gadolinium enhancement.

Main Results:

• Ventricular myocardial abnormalities were found in 52.6% of patients with fQRS versus 29.7% without fQRS (P < 0.0001).
• Ischemic heart disease was present in only 27% of patients with fQRS.
• An electrocardiographic scoring system was developed to differentiate fQRS with and without ventricular abnormalities.

Conclusions:

• The utility of fQRS depends on the prevalence of ventricular disease in the studied population.
• fQRS is frequently associated with ventricular abnormalities, with or without myocardial scar.
• fQRS can also appear in individuals without clinical heart disease.