Increased Prevalence of Fragmented QRS in Randomly Selected Group of Multiple Myeloma Patients: A Pilot Study to Assess Prevalence.

Angel López-Candales,Fuad Habash,Srikanth Vallurupalli

doi:10.7759/cureus.20635

Abstract

The presence of fragmented QRS (fQRS) on surface electrocardiograms (ECGs) has been associated with the myocardial scar in certain cardiac conditions and has been proposed as a potential marker of adverse cardiac outcomes. Since myocardial fibrosis not only has been recognized as a side effect of certain cancer therapies but also, fQRS have been shown in some breast cancer and lymphoma survivors post-chemotherapy treatment, we decided to investigate if fQRS could also be seen in multiple myeloma (MM) patients since this association has never been described. For this pilot study, we analyzed ECGs from 137 randomly selected MM patients during different stages of their treatment, and fRQS was found in 42% of these cases. The prevalence was much higher than the reported prevalence for the general population (19.0%) but closer to that reported for patients with myocardial infarction (39.5%). We also found that female MM patients are more commonly affected than women in the general population. Based on this small random sampling analysis, fQRS appears highly prevalent among unselected MM patients. This novel finding of fQRS in MM patients certainly adds to the growing data of cases among different cancer patients, opening the door to conduct larger prospective studies that undoubtedly will help to create a more robust database regarding the potential utility of this ECG abnormality.

Highlights

Fragmentation of the QRS from surface electrocardiograms (ECG) is a term that has been recently used to characterize subtle conduction abnormalities that include abnormal slurrings, notching, or aberrancies seen within QRS complexes
Since myocardial fibrosis has been recognized as a side effect of certain cancer therapies and, fragmented QRS (fQRS) have been shown in some breast cancer and lymphoma survivors post-chemotherapy treatment, we decided to investigate if fQRS could be seen in multiple myeloma (MM) patients since this association has never been described
This novel finding of fQRS in MM patients certainly adds to the growing data of cases among different cancer patients, opening the door to conduct larger prospective studies that undoubtedly will help to create a more robust database regarding the potential utility of this ECG abnormality

Summary

Introduction

Fragmentation of the QRS (fQRS) from surface electrocardiograms (ECG) is a term that has been recently used to characterize subtle conduction abnormalities that include abnormal slurrings, notching, or aberrancies seen within QRS complexes. FQRS was later identified as a marker of depolarization abnormality and was considered a potential noninvasive marker for identifying patients at risk of sudden cardiac death [3] This conceptualization was derived from the notion that alteration of electrical signals traversing the myocardium will distort QRS morphology because of the resultant inhomogeneous activation that will occur as electrical signals travel across the myocardium and their conduction is altered by interspersed myocardial scarring within the cardiac architecture [3]. These findings changed the prior notion that fQRS was no longer specific for coronary disease since it could be linked to other cardiac conditions such as nonischemic cardiomyopathy, congenital heart disease, arrhythmogenic right ventricular dysplasia cardiomyopathy, and the Brugada syndrome that were characterized by some pathological process resulting in myocardial fibrosis [4-8]. The prevalence of finding fQRS increases significantly to 53.8% in those patients dying from sudden cardiac death [9]

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