Fragmented QRS Research Articles (Page 1)

The association between fragmented QRS and left ventricular diastolic dysfunction in type 2 diabetes patients with or without microalbuminuria.

Cancer therapy-related cardiac dysfunction (CTRCD) remains a critical limitation of cancer therapy, with implications for morbidity and survivorship. Echocardiography is an established surveillance tool, while electrocardiography (ECG) may offer earlier, low-cost detection of subclinical cardiotoxicity. The relative diagnostic yield of these modalities is uncertain. To systematically review and compare echocardiography and ECG for early detection of CTRCD in patients receiving cancer therapy. Following PRISMA 2020 guidelines, PubMed, Embase, Scopus, and CENTRAL were searched through May 2025. Eligible studies included prospective or retrospective cohorts reporting echocardiographic and ECG outcomes in adults undergoing chemotherapy. Data on left ventricular ejection fraction (LVEF), diastolic function, global longitudinal strain (GLS), and ECG abnormalities were extracted. Pooled incidence and effect estimates were calculated using random-effects models. Risk of bias was assessed with QUADAS-2. Thirteen cohort studies involving 1440 patients were included. The pooled incidence of echo-defined CTRCD was 10% (95% confidence interval [CI] 7%-16%), with higher rates among anthracycline-treated cohorts. Diastolic dysfunction and GLS reduction occurred in up to 40% of patients, frequently preceding a decline in LVEF. ECG abnormalities were observed in 35% (95% CI 22%-49%), most commonly QTc prolongation, ST-T changes, fragmented QRS, and atrial fibrillation. Routine ECG demonstrated low sensitivity compared with echocardiography, though continuous monitoring and AI-enhanced ECG showed potential for earlier detection. Echocardiography remains the cornerstone for CTRCD surveillance, with GLS and diastolic indices providing early warning. ECG abnormalities are frequent but inconsistent predictors; their role may expand with continuous and AI-based approaches. A multimodal surveillance strategy integrating echo and advanced ECG may improve cardio-oncology care.

Increased fragmented QRS and decreased basophil in earthquake-related post-traumatic stress disorder.

Relationship Between QRS Fragmentation on Electrocardiogram and Myocardial Scar Characterization on Cardiac Magnetic Resonance Imaging in Patients With Ischemic and Nonischemic Cardiomyopathy.

Background and Objectives: Atrial fibrillation (AF) is a common arrhythmia in patients with mitral valve prolapse (MVP) after mitral valve repair surgery and is associated with adverse cardiac outcomes. Early identification of patients at high risk for AF development after repair surgery is crucial for early treatment and follow-up of these patients. This study aimed to identify ECG predictors of AF in patients with MVP following mitral valve repair surgery. Materials and Methods: This retrospective, non-randomized study included 62 patients who underwent mitral valve repair for MVP. The patients’ ECGs were analyzed preoperatively and at 1, 3, and 6 months post-surgery to identify patients who developed AF. AF was diagnosed based on ECG findings or Holter monitoring. The P wave dispersion, P wave peak time (PWPT), P wave duration, PR interval, P wave terminal force in lead V1 (PWTF), interatrial block, P wave axis, biphasic P waves in inferior leads, QRS duration, corrected QT interval (QTc), fragmented QRS (fQRS), and ST segment-T wave abnormalities were analyzed on baseline ECG as AF predictors. Results: The PWPT, P wave dispersion, and maximum P wave duration were significantly longer on preoperative ECG in patients who developed AF postoperatively compared to those who did not. Biphasic P waves were more frequently observed in patients who developed AF postoperatively. Univariate analysis identified biphasic P waves, P wave dispersion, maximum P wave duration, PWPT, and left ventricular ejection fraction (LVEF) as potential predictors of postoperative AF. However, multivariate analysis revealed that P wave dispersion, PWPT, and left atrial volume index (LAVI) were independent predictors of AF in six months after mitral valve repair. No significant changes were observed in QRS duration, QT interval, or the fQRS. Conclusions: The P wave dispersion, PWPT, and LAVI are significant ECG predictors of AF following mitral valve repair surgery in MVP patients. These ECG markers may help identify individuals at higher risk for postoperative AF, allowing for targeted monitoring and management strategies.

Background: Fragmentation of QRS (fQRS) complex is a readily assessable, non-invasive electrocardiographic marker. Methodology: In the Department of Cardiology of DMCH, this observational study was carried out between June 2017 to May 2018. A total of 100 patients were taken as study population. Sample population was categorized into two groups according to presence or absence of fQRS in V4-V6 leads of 12 lead ECG. Group A represents anterior ASTEMI with fQRS and group B represents anterior ASTEMI without fQRS. Then echocardiographic evaluation was done for presence or absence of LVAT in both groups. Statistical analysis was performed using SPSS version 23.0. Results: Among 100 patients, 24 patients were enlisted in group A and 76 patients were enlisted in group B. The average age of participants in group A was 48.0±11.7, while in group B it was 53.6±12.4. Males constituted the majority in both groups, comprising 83.3% (20 individuals) in group A and 75.0% (57 individuals) in Group B. Mean left ventricular end-diastolic diameter was 52.4±2.9 mm vs 49.9±4.7 mm (p<0.05) in group A vs B respectively. The mean left ventricular end-systolic diameter was 42.1±4.1 mm (group A) vs 35.1±4.2 mm (group B) which was statistically significant (p<0.05). The mean ejection fraction of the left ventricle measured 35.7% ± 4.8 in group A and 39.0% ± 5.3 in group B which was found statistically significant (p < 0.05). Thirteen (54.2%) patients were found to have akinesia in echocardiography in group A and 14 (18.4%) in group B. In Group A, over half of the patients (54.2%) had LVAT compared to 9 patients (11.8%) in Group B. This difference between the two groups reached statistical significance (p < 0.05). Presence of fQRS had 6.896 times (95% CI 2.097% to 22.675%) increase in odds of having LVAT. Conclusion: fQRS in leads V4–V6 on 12-lead ECG is an independent predictor of LVAT formation among patients experiencing their first episode of anterior ASTEMI.

Usefulness of Additional ECG Indicators for Prognosis Prediction in Patients With Cardiac Sarcoidosis.

Prevalence and relation to training of electrocardiographic findings in Caucasian children and adolescents 8- to 18-year-old practicing competitive sport

ABSTRACTBackgroundRisk stratification for ventricular fibrillation (VF) in patients with Brugada syndrome (BrS) remains a significant clinical challenge. Atrial fibrillation (AF) is relatively common in BrS, suggesting arrhythmogenic abnormalities in both the atria and ventricles. The purpose of this study was to investigate the relationship between P‐waveforms and VF occurrence in patients with BrS.MethodEighty‐two patients with BrS were retrospectively evaluated and classified into two groups based on the occurrence of VF during the overall clinical course: VF occurrence (n = 34) and VF nonoccurrence (n = 48). The relationship between VF occurrence and parameters on 12‐lead electrocardiogram (ECG) at the initial visit, prior to any drug administration, was analyzed.ResultsDuring a median follow‐up of 75.0 months, VF occurred in 23 patients, including 19 recurrent and four new cases. Multivariable logistic regression identified notched P‐wave as an independent risk factor for VF occurrence in all models (odds ratios 6.45–8.45; all p < 0.01). Depending on the model, symptomatic BrS, early repolarization pattern, and fragmented QRS were also independently associated with VF. Kaplan–Meier analysis showed a significantly lower incidence of VF in patients with BrS who have neither a history of VF nor a notched P‐wave (p < 0.0001).ConclusionsNotched P‐wave on 12‐lead ECG is a significant risk factor for the occurrence of VF in patients with BrS. Notched P‐wave in patients with BrS may indicate the presence of an underlying arrhythmogenic substrate predisposing to VF.

Background: Obesity (OB) is an independent risk factor for arrhythmias and sudden death (SD) which accounts for ~50% of deaths in OB population, predominantly affecting men (75%). Yet, the mechanisms involved remain poorly defined. We hypothesized that OB creates a proarrhythmogenic substrate that increases the risk to develop malignant ventricular arrhythmias leading to SD. Aim: To characterize the electrical ventricular phenotype in severely obese melanocortin type 4 receptor knockout (MC4R KO) male mice. Methods: In-vivo ECGs were obtained from anesthetized MC4R KO and c57bl/6 lean (WT) adult male mice. Ventricular conduction velocity (CVv) was measured by optically mapping Langendorff perfused hearts (Di-4-ANEPPS) with simultaneous ECGs recording. Spontaneous and triggered arrhythmias were quantified using a ventricular arrhythmia severity score (VASs) ranging from zero (no arrhythmia) to five (Torsade de point, TdP). QT intervals were quantified from ECGs and corrected applying Mitchell’s formula (QTc). Experiments were done at 37°C with blebbistatin to prevent contraction. Data is reported as mean±SEM. Unpaired T-test was used. Results: Averaged weights: MC4R KO: 59±1.2 g (N=8), WT: 30±1.3 g (N=7). At 60 weeks of age MC4R KO survival rate was 55% vs 100% in WT (N=40/group). ECGs from MC4R KO showed a prolonged QTc compared to WT (44.7±0.9 [N=8] vs 28.6±1.7 ms [N=7]; p&lt;0.01). On average, QTc in MC4R KO was lengthened by 36% respect to WT (p&lt;0.01). While 50% of MC4R KO showed an increased incidence of complex arrhythmias including fragmented QRS (f-QRS ≥3 peaks), alternans (f-QRS/QRS), ventricular tachycardia and fibrillation, and TdP (total arrhythmia burden increased), WT only exhibited isolated PVCs and 2 peaks f-QRS. On average, MC4R KO hearts spend 15.4% of total experimental time (N=6) in arrhythmia vs 0.1% in WT (N5) (p&lt;0.03). Both cumulative (C) and average (A) VASs were increased in MC4R KO compared to WT (C: 25 vs 2; A: 8.3 vs 1; p&lt;0.02). Although we did not find differences in transversal (T) and longitudinal (L) CV between MC4R KO and WT (CVT: 35.2±4.5 vs 36.9±1.4 cm/s; CVL: 59.7±7.5 vs 72.4±4.8 cm/s; N=6, 5), dispersion increased by 3.7 (CVT) and 1.7 (CVL) folds respectively in MC4R KO, suggesting a rise in CVv heterogeneity. Conclusion: Obese MC4R KO mice exhibit increased arrhythmia burden with prolonged QTc and unchanged CVv, suggesting that a delayed ventricular repolarization plays a key role in increasing the risk of SD in these mice.

Risk stratification is essential in managing patients with non-ST-elevation myocardial infarction (NSTEMI). While multiple risk scores exist, their validation in developing countries like India remains limited. This study compares the predictive accuracy of the PURSUIT, HEART, TIMI, GRACE 2.0, and CAMI-NSTEMI scores for major adverse cardiovascular events (MACE), including death, non-fatal myocardial infarction, emergency percutaneous coronary intervention, and coronary artery bypass grafting, in NSTEMI patients. This was a single-center prospective observational study wherein patients diagnosed with NSTEMI were enrolled. Detailed clinical histories, including symptomatology and risk factors, were recorded. Five risk scores (TIMI, GRACE 2.0, PURSUIT, HEART, and CAMI-NSTEMI scores) were computed. Outcomes were assessed for in-hospital, 14-day, six-month, and one-year MACE. A total of 1102 patients were enrolled, with a mean age of 59.6±11.2 years. MACE occurred in 140 patients (12.7%), with 89 deaths (8.1%). Patients with MACE were older and more likely to smoke or have hypertension, diabetes, or stroke. Multivariate logistic regression analysis identified angina in the last 48 hours, diabetes, smoking, cardiac arrest, and fragmented QRS on electrocardiogram as independent MACE predictors. TIMI showed the highest predictive ability for in-hospital MACE, while GRACE excelled for 14-day, 6-month, and 1-year outcomes. All risk scores effectively predicted short- and intermediate-term MACE, with GRACE performing best for longer-term predictions.

ECG-derived DETERMINE score can provide information about procedure success in chronic total occlusion patients.

Sudden cardiac death (SCD) remains a major cause of death despite progress in prevention and intervention of cardiac diseases. The most common cause of nonischemic SCD in young individuals in Northern Finland is primary myocardial fibrosis (PMF). Fingesture study consists of 5869 prospectively collected subjects with SCD from Northern Finland collected from 1998 to 2017. Nonischemic etiology was the cause of SCD in 1477 (25%) subjects out of which primary myocardial fibrosis was the cause of SCD in 184 (12%) subjects (65% men, median age 55 ± 16 years). We examined the ante mortem ECG and medical history of the subjects to discover preceding symptoms and ECG changes. Prior health care contact in electronic health record system (EHR) was found for 89 (48%) subjects and ECG was available for 52 (28%) subjects. Both medical history and ECG were available for 20 subjects (11%). We observed that transient loss of consciousness (TLOC) was the most common symptom recorded and was reported by 33 (37%) subjects. ECG was abnormal in 38 (73%) subjects. Fragmented QRS (fQRS) complex was found in 26 (50%) subjects. Vast majority, 87% of subjects had either TLOC or abnormal ECG. Only seven subjects with ECG or EHR history available had normal ECG and did not have TLOC. Many SCD victims with primary myocardial fibrosis had abnormal ECG or history of TLOC. The results suggest that the combination should generate careful cardiovascular examination to detect underlying myocardial disease and possibly prevent SCD.

Electrocardiogram evolution in Anderson-Fabry disease patients during follow-up in relation to specific treatment and cardiac disease progression.

Prediction of response to cardiac resynchronization therapy using electrocardiographic criteria: A systematic review.

Dear Editor-in-Chief, We are writing to express our views on the recently published article titled "Fragmented QRS Pattern Predicts Poor Prognosis in Sepsis and Septic Shock" by Karabacak et al.. We commend the authors for addressing an important and clinically relevant topic that explores the prognostic value of fragmented QRS (fQRS) patterns in patients with sepsis and septic shock. The study provides valuable insights into the association between fQRS patterns and short-term overall survival in critically ill patients. The authors' findings that fQRS patterns independently predict worse outcomes, alongside the need for mechanical ventilation and its duration, are particularly noteworthy. This observation could significantly influence the clinical management and risk stratification of septic patients. However, we would like to share some constructive comments and raise questions that may further refine the understanding of this important subject.

Introduction: The 2023 European Society of Cardiology Cardiomyopathy Guidelines emphasize the crucial role of a multiparametric approach in diagnosing. During the diagnostic workup of hypertrophic cardiomyopathy, besides echocardiography and cardiac magnetic resonance, ECG plays an important role. Based on literature data, only 4–18% of patients with hypertrophic cardiomyopathy have normal ECG, however, ECG deviations are often non-specific. Objective: To evaluate the ECG characteristics in a hypertrophic cardiomyopathy patient cohort followed-up at the Heart Failure Outpatient Clinic of Gottsegen National Cardiovascular Center. Method: We retrospectively analyzed the data and the first ECGs registered of patients with hypertrophic cardiomyopathy, diagnosed by cardiac magnetic resonance and/or genetic testing, followed-up between 01. 11. 2023 and 30. 09. 2024 at our Heart Failure Outpatient Clinic. Results: Data from 72 patients were evaluated, male: 58%, age: 49 (34–62) years, left ventricular ejection fraction: 63 (47–72)%, NYHA functional class: 2 (1–2), ICD/CRT-D: 47%. Based on the left ventricular outflow tract obstruction of ≥30 mmHg, 31% of the patients belonged to hypertrophic obstructive cardiomyopathy subgroup. Based on the ECGs analyzed, atrial fibrillation occurred in 6%. Interatrial conduction disturbances affected 29% of the patients. Atrioventricular and intraventricular conduction disturbances occurred in 50% (AV block: 20% [grade I: 18%, grade II: 2%, grade III: 0%], right bundle branch block: 14%, left bundle branch block: 16%, left anterior hemiblock: 13%, left posterior hemiblock: 3%, non-specific intraventricular conduction disturbance: 8%). The sensitivity of the Cornell, Sokolow–Lyon, and Peguero–Lo Presti “high voltage” criteria were low (23–14–25%). Pathological Q wave occurred in 42% of the patients, QRS fragmentation in 43% and corrected QT interval prolongation in 44%. T wave inversion was present in 94%, significant ST elevation in 21%, ST depression in 48%, while only 3% of patients had negative ECG. The only difference between hypertrophic obstructive cardiomyopathy and non-obstructive hypertrophic cardiomyopathy patients was the fulfillment of the Cornell criterion (45% vs. 15%, p = 0.044). Conclusions: A multimodal approach is essential in the diagnosis of hypertrophic cardiomyopathy. Based on our results, hypertrophic cardiomyopathy is often associated with heterogeneous ECG abnormalities. However, the early recognition of the ECG variations may help in the further diagnostic steps, contributing to the initiation of disease-modifying treatment. Orv Hetil. 2025; 166(25): 970–981.

Background Coronary no-reflow is associated with adverse outcomes in patients with myocardial infarction (MI). This study aimed to evaluate the association between the presence of fragmented QRS (fQRS) and no-reflow in MI patients. Methods A systematic search was conducted across four databases from inception to July 20, 2024. The inclusion criteria were studies that enrolled MI patients, stratified by the presence of fQRS, and reported at least one of the following outcomes: no-reflow, infarct size, reinfarction, or repeat revascularization during hospitalization. No-reflow was defined as a Thrombolysis In Myocardial Infarction (TIMI) flow grade < 3. Results A total of 19 studies with 5840 participants were analyzed using a random-effects model. The presence of fQRS was associated with a higher risk of no-reflow compared to non-fQRS in MI patients, with an odds ratio (OR) of 2.08 (95% CI 1.39 to 3.12), P < 0.01. Subgroup analysis by study design supported this finding. However, there were no significant differences in infarct size, in-hospital reinfarction, or need for repeat revascularization between groups. Conclusions The presence of fQRS was associated with a higher risk of no-reflow in MI patients. fQRS could serve as a useful tool for predicting no-reflow and guiding primary prevention strategies in MI patients.

In humans with arrhythmogenic cardiomyopathy (ACM) late-phase depolarization and repolarization abnormalities, such as epsilon (ɛ) waves and T wave inversion (TWI), are commonly observed in right precordial leads (V1-V3). This myocardial disorder has also been described in Boxer and English bulldogs (EBs), but data on electrocardiographic alterations in these breeds are lacking. The objective of this study was to describe electrocardiographic abnormalities in EBs with ACM, comparing QRS complexes and T waves with ≤ 5-year-old EBs without phenotypic expression of the disease. This is a retrospective study including 59 EBs (37 with ACM-ACM group and 22 healthy-healthy group). Standard echocardiographic, and 12-lead electrocardiogram data were retrospectively analyzed. In all leads QRS complex, R-peak time (RPT), and R peak-end time (RPE) were evaluated. Terminal activation duration (TAD), TWI, and presence of ɛ wave, defined as a positive small spike wave in right limb (aVR) and right precordial (V1) leads, were evaluated and compared with echocardiographic measurements. Arrhythmogenic cardiomyopathy group showed wider QRS complexes in all leads due to longer RPE (P < 0.05). The TAD in lead V1 was longer in ACM group (P < 0.001). The TWI and ɛ wave in ACM group were respectively present in 19% and 32%. Prolonged QRS complex and RPE in duration V1, the ɛ wave in lead aVR and V1, TWI and prolonged TAD in V1 were correlated with echocardiographic parameters defining right ventricular systolic function (P < 0.05). The presence of fragmented QRS complexes in limb and precordial leads, the prolongation of the RPE, the prolongation of TAD in V1, the presence of ɛ wave, can all be considered electrocardiographic features associated with ACM in EBs.

BACKGROUND: Complete left bundle branch block is a classic example of an electrocardiogram that is non-informative when assessed using conventional criteria for myocardial ischemia. QRS duration is an established electrocardiographic marker of ventricular dyssynchrony and is used to predict the clinical course of chronic heart failure. Fragmented QRS, a less studied electrocardiographic parameter that reflects myocardial scarring, has emerged as a negative prognostic marker in coronary artery disease, being associated with recurrent cardiovascular events, hospitalizations, and mortality in patients with narrow QRS complexes. However, data on the value of fragmented QRS in the setting of wide QRS complexes remain limited. AIM: To conduct a comparative analysis of the clinical, instrumental, and epidemiologic characteristics of patients with coronary artery disease and complete left bundle branch block, with consideration of the fragmented QRS presence. MATERIALS AND METHODS: The study included 45 hospitalized patients with coronary artery disease (mean age 76±8 years). The main group consisted of 10 patients with fragmented QRS, and the control group included 35 patients without fragmented QRS. At the first stage (2018–2019), clinical history, electrocardiographic parameters, and echocardiographic characteristics (global and regional left ventricular contractility) were assessed. At the second stage (2024), medical records were analyzed using the Unified Medical Information and Analytical System. RESULTS: Patients in the main group had longer QTc intervals (463 vs 433 ms in the control group; p=0.028), wider QRS complexes (160 vs 120 ms; p=0.009), and slightly lower left ventricular ejection fraction (34.2±14.4% vs 42.8±13.9%; p=0.063). The groups differed significantly in the severity of chronic heart failure (p=0.043), with stage 2B CHF (CHF was assessed using the Strazhesko classification which is commonly applied in clinical practice in Eastern Europe and Russia) observed in 80% of the main group vs 49% of the control group. The median number of fragmented leads was 4.5. Cardiovascular-related hospitalizations were slightly more frequent in the main group (p=0.061). A total of 27 deaths were recorded, most due to noncardiac causes. Death due to progression of chronic heart failure occurred in 30% of the main group and 17.1% of the control group. There were no significant differences in the mortality structure between groups. CONCLUSION: The presence of fragmented QRS complexes on electrocardiogram in patients with complete left bundle branch block is associated with further QRS widening and QTc prolongation, a trend toward reduced left ventricular ejection fraction, increased frequency of cardiovascular-related hospitalizations, and progression of heart failure severity. These findings may be considered in the development of prognostic models for patients with coronary artery disease and initially abnormal QRS complexes.