QRS fragmentation is associated with increased risk of ventricular arrhythmias in high-risk patients; Data from the SMASH 1 Study

Annals of noninvasive electrocardiology: the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc

article

Nur Sourour MD¹  Egil Riveland MD³  Terje Rømo MD³  Patrycja Næsgaard MD, PhD³  Harald Kjekshus MD, PhD¹  Alf Inge Larsen MD, PhD³  Torbjørn Omland MD, PhD, MPH¹  Helge Røsjø MD, PhD²  Peder Langeland Myhre MD, PhD¹ 

[1] Department of Cardiology, Division of Medicine, Akershus University Hospital;Institute of Clinical Medicine, University of Oslo;Department of Cardiology, Stavanger University Hospital;Institute of Clinical Sciences, University of Bergen;Division for Research and Innovation, Akershus University Hospital

关键词: cardiac arrest;    implantable cardioverter-defibrillator;    QRS fragmentation;    risk prediction;    ventricular arrhythmia;   

DOI  :  10.1111/anec.12985

来源: Wiley

【 摘 要 】

Introduction QRS fragmentation (fQRS), defined as the presence of additional spikes within the QRS complex, has been associated with myocardial conduction abnormalities and arrhythmogenicity. Objective We aimed to assess whether fQRS is associated with incident ventricular arrhythmias (VA) in high-risk patients treated with implantable cardioverter-defibrillator (ICD) for primary and secondary prevention. Methods In a prospective observational multicenter study, we included 495 patients treated with ICD. fQRS was analyzed according to previously validated criteria, by two physicians blinded for outcome data. Incident VA were obtained from ICD recordings. Results ECG recordings interpretable for fQRS were available in 459 patients (93%), aged 66 ± 12 years with left ventricular ejection fraction 40% ± 13%. fQRS was present in 52 patients (11%) with comparable baseline characteristics to patients without fQRS, except higher age, higher prevalence of coronary artery disease (CAD), lower prevalence of cardiomyopathy, and more frequently a secondary prevention ICD indication. Among patients with native QRS, those with fQRS had similar QRS duration and axis to those without fQRS. During 3.1 ± 0.7 years follow-up, 126 patients (28%) had ≥1 VA . fQRS was associated with increased risk of VA (HR 3.41 [95% CI 2.27–5.13], p  < .001), which persisted after adjusting for age, gender, sex, BMI, CAD, heart failure, renal function, ICD indication, QRS duration, QRS axis, Q waves, and bundle branch block. fQRS was more strongly associated with VA in patients with a primary (HR 6.05 [95% CI 3.16–11.60]) versus secondary (HR 2.39 [95% CI 1.41–4.04]) ICD indication ( p -for-interaction = .047). Conclusions fQRS is associated with threefold increased risk of VA in high-risk patients, independent of established risk factors.

【 授权许可】

Unknown