We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
QRS Fragmentation and the Risk of Sudden Cardiac Death in MADIT II.
- Authors
BRENYO, ANDREW; PIETRASIK, GRZEGORZ; BARSHESHET, ALON; HUANG, DAVID T.; POLONSKY, BRONISLAVA; McNITT, SCOTT; MOSS, ARTHUR J.; ZAREBA, WOJCIECH
- Abstract
QRS Fragmentation and the Risk of Sudden Cardiac Death in MADIT II. Background: QRS fragmentation (fQRS) has been reported as a useful ECG parameter in predicting mortality in high-risk postinfarction patients. Its prognostic value for sudden cardiac death (SCD) and ventricular arrhythmias in ischemic cardiomyopathy (ICM) remains unknown. Methods: MADIT II enrollment 12-lead ECGs were analyzed for fQRS defined as RSR' patterns (≥1 R' or notching of S or R wave) in patients with a normal QRS duration and >2 notches on the R or S wave in patients with abnormal QRS duration, present in 2 contiguous leads. Exclusion criteria included a paced rhythm and an uninterpretable or incomplete ECG. Study endpoints included SCD, SCD or appropriate implantable cardioverter defibrillator (ICD) shock, and total mortality (TM). Results: Of the 1,232 ECGs reviewed, 1,040 were of suitable quality for fQRS analysis. QRS fragmentation was found in 33% of patients in any leads, in 10% of patients in anterior leads, in 8% of patients in lateral leads and in 21% of patients in inferior leads. Anterior and lateral location of QRS fragmentation was not associated with follow-up events. Inferior location of fQRS was found to be predictive of SCD/ICD shock (hazard ratio [HR] 1.46, P = 0.032), SCD (HR 2.05, P = 0.007), and TM (HR 1.44, P = 0.036). This association was driven primarily by the increase in events found in LBBB patients: SCD/ICD shock (HR 2.05, P = 0.046), SCD (HR 4.24, P = 0.002), and TM (HR 2.82, P = 0.001). Conclusions: Fragmented QRS, especially identified in inferior leads, is predictive of SCD, SCD or appropriate ICD shock, and all-cause mortality in patients with ICM. Identifying inferior fQRS in patients with LBBB is of particular prognostic significance and should reinforce the use of ICD therapy in this high-risk group. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1343-1348, December 2012)
- Subjects
TREATMENT of cardiomyopathies; CARDIAC arrest; VENTRICULAR arrhythmia; CHI-squared test; ELECTROCARDIOGRAPHY; FISHER exact test; IMPLANTABLE cardioverter-defibrillators; CARDIOMYOPATHIES; RESEARCH funding; SURVIVAL analysis (Biometry); T-test (Statistics); SECONDARY analysis; RETROSPECTIVE studies; DATA analysis software; DESCRIPTIVE statistics; CARDIOVASCULAR diseases risk factors; DISEASE risk factors
- Publication
Journal of Cardiovascular Electrophysiology, 2012, Vol 23, Issue 12, p1343
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/j.1540-8167.2012.02390.x