Comparison of the Response to Cardiac Resynchronization Therapy Defibrillator Implantation Between Patients With and Without Fragmented QRS in Electrocardiography
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Abstract
Background: Myocardial scars cause heterogeneous ventricular activation, which results in fragmented QRS (f-QRS) complexes and the resultant left ventricular (LV) dysfunction and dyssynchrony and thus further mortality. The accurate management of this patient population is essential to lessen mortality and improve the quality of life.
Methods: The present cross-sectional study recruited 80 patients (40 with f-QRS and 40 with non–f-QRS) who underwent cardiac resynchronization therapy defibrillator (CRT-D) implantation and followed them up for 6 months. The 2 groups were compared, before and after CRT-D implantation, concerning the New York Heart Association functional class; the quality of life; the incidence of all arrhythmias, including tachyarrhythmias; echocardiographic findings; the number of hospitalization; and mortality.
Results: The study population consisted of 80 patients at a mean age of 62.05±11.25 years: 40 cases with f-QRS and 40 with non–f-QRS. Men comprised 68.8% (n=55) of the patients. Ischemic cardiomyopathy was detected in 62.5% of the patients, nonischemic cardiomyopathy in 37.5%, and sinus rhythm in 76 cases. The mean values of the LV ejection fraction, the LV end-diastolic diameter, and the LV end-systolic diameter in both groups were 17.12±5.77, 6.44±0.81, and 5.70±0.81, respectively (P<0.05). An improvement was observed among the patients with non–f-QRS in echocardiography after CRT-D implantation, which was not related to the incidence of ischemic or nonischemic LV dysfunction. Dyspnea on exertion and mitral regurgitation improved in both groups (P>0.05).
Conclusions: The presence of f-QRS in patients with heart failure could confirm a diminished response to CRT-D implantation according to echocardiographic findings and could be considered an accurate patient selection guide. (Iranian Heart Journal 2021; 22(2): 77-82)
Mittal SR. Fragmented QRS: a simple electrocardiographic prognostic marker in cardiovascular disease. Journal of Clinical and Preventive Cardiology. 2016 Jul 1;5(3):94.
Mithilesh K. Das, MD; Hussam Suradi, MD; Waddah Maskoun, MD and et al. Fragmented Wide QRS on a 12-Lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythmy Electrophyysiol. Aha journal.2008; 1: 258-68
Das MK, Suradi H, Maskoun W, Michael MA, Shen C, Peng J, Dandamudi G, Mahenthiran J. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circulation: Arrhythmia and Electrophysiology. 2008 Oct 1; 1(4):258-68.
Yaman M, Arslan U, Bayramoglu A, Bektas O, Gunaydin ZY, Kaya A. The presence of fragmented QRS is associated with increased epicardial adipose tissue and subclinical myocardial dysfunction in healthy individuals. Revista portuguesa de cardiologia. 2018 Jun 1; 37(6):469-75.
Pietrasik G, Goldenberg I, Zdzienicka J, Moss AJ, Zareba W. Prognostic significance of fragmented QRS complex for predicting the risk of recurrent cardiac events in patients with Q-wave myocardial infarction. The American journal of cardiology. 2007 Aug 15; 100(4):583-6.
Mahenthiran J, Khan BR, Sawada SG, Das MK. Fragmented QRS complexes not typical of a bundle branch block: a marker of greater myocardial perfusion tomography abnormalities in coronary artery disease. Journal of nuclear cardiology. 2007 May 1; 14(3):347.
Das MK, Maskoun W, Shen C, Michael MA, Suradi H, Desai M, Subbarao R, Bhakta D. Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. Heart rhythm. 2010 Jan 1;7(1):74-807)
Cipolletta L, Luzi M, Brambatti M, Matassini M, Guerra F, Capucci A. PROGNOSTIC VALUE OF FRAGMENTED QRS IN CRT-D PATIENTS: 3.22. 10. Journal of Cardiovascular Electrophysiology. 2011 Oct 1; 22.
Das MK, Suradi H, Maskoun W, Michael MA, Shen C, Peng J, Dandamudi G, Mahenthiran J. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circulation: Arrhythmia and Electrophysiology. 2008 Oct 1; 1(4):258-68.
Brandon K. Fornwalt, PhD; John D. Merlino, MD; Derek A. Fyfe, MD and et all. Agreement is poor Amongst Current Criteria Used to Define Response to Cardiac Resynchronization Therapy. Circulation NIH- PA Author Manuscript. May. 2010. 11; 121 (18): 1985-1991.
Das MK, Saha C, El Masry H, Peng J, Dandamudi G, Mahenthiran J, McHenry P, Zipes DP. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm. 2007 Nov 1;4(11):1385-92
Aslani A, Tavoosi A, Emkanjoo Z. Diffuse fragmented QRS as an index of extensive myocardial scar. Indian Pacing Electrophysiol J. 2010; 10(1):67-8.
Nooriasl, S., Khademzadeh, R., & Emkanjoo, Z. (2021). Comparison of the Response to Cardiac Resynchronization Therapy Defibrillator Implantation Between Patients With and Without Fragmented QRS in Electrocardiography. Iranian Heart Journal, 22(2), 77-82.
MLA
Samaneh Nooriasl; Rohangiz Khademzadeh; Zahra Emkanjoo. "Comparison of the Response to Cardiac Resynchronization Therapy Defibrillator Implantation Between Patients With and Without Fragmented QRS in Electrocardiography". Iranian Heart Journal, 22, 2, 2021, 77-82.
HARVARD
Nooriasl, S., Khademzadeh, R., Emkanjoo, Z. (2021). 'Comparison of the Response to Cardiac Resynchronization Therapy Defibrillator Implantation Between Patients With and Without Fragmented QRS in Electrocardiography', Iranian Heart Journal, 22(2), pp. 77-82.
VANCOUVER
Nooriasl, S., Khademzadeh, R., Emkanjoo, Z. Comparison of the Response to Cardiac Resynchronization Therapy Defibrillator Implantation Between Patients With and Without Fragmented QRS in Electrocardiography. Iranian Heart Journal, 2021; 22(2): 77-82.
)