Fragmented QRS may be associated with complex ventricular arrhythmias in mitral valve prolapse

Although mitral valve prolapse (MVP) is a benign disease, several studies have indicated its association with ventricular arrhythmias (VAs). Some histopathological studies have pointed to left ventricular fibrosis as the underlying cause of arrhythmia in MVP patients. Fragmented QRS (fQRS) on electrocardiography (ECG) has been shown to be a marker of myocardial fibrosis. This study aimed to investigate the association between fQRS and complex VAs in patients with MVP.

A total of 230 consecutive patients who were diagnosed with MVP were included in the study. The control group consisted of 302 healthy individuals matched according to age and sex. fQRS was defined as additional R' wave or notching/splitting of S wave in two contiguous ECG leads. All patients underwent 24-hour Holter monitoring and VAs were classified using Lown's scoring system. Lown class ≥3 VAs were considered as complex VAs.

As compared to the healthy individuals, prevalence of fQRS (40% vs. 9.6%, P<0.001) and complex VAs (18.7% vs. 0%, P<0.001) were significantly higher in patients with MVP. Furthermore, complex VAs (35.9% vs. 7.2%, P=0.001) were significantly higher in MVP patients with fQRS. In multiple logistic regression analysis, the presence of bileaflet prolapse (OR: 2.567, 95%CI: 1.434 to 4.367; P=0.002) and presence of fQRS (OR: 3.021, 95%CI: 1.556 to 6.232; P<0.001) were independent predictors for complex VAs.

The presence of fQRS may be associated with complex VAs in patients with MVP. Therefore, fQRS may be used in risk stratification of complex VAs in patients with MVP.