Fragmented QRS and arrhythmic events in patients with implantable cardioverter‑defibrillators

Abstract

Background Patients with implantable cardioverter‑defibrillators (ICDs) may experience recurrent arrhythmic events (AE). Identification of these patients may help plan further therapy. Fragmented QRS (fQRS) was identified as a risk marker of AE in various populations but its predictive value in patients with ICD has not been established. aims To examine whether fQRS is a risk marker of future AE in patients with ICD. methods We retrospectively analyzed demographic, clinical, electrocardiographic (ECG), procedural, and follow‑up data of 367 consecutive patients who received ICD in a single tertiary center. A 12‑lead ECG recorded at the time of implantation was analyzed for the presence of fQRS. The analyzed primary endpoint was AE and total mortality was a secondary endpoint. results During follow‑up lasting mean (SD) 34.5 (18) months, 146 patients (40%) had AE and total mortality was 18% (67 patients). Univariate analysis identified 7 parameters associated with AE of which 2—ICD implantation for secondary prevention (odds ratio [OR], 2.13; 95% CI, 1.13–4.025; P = 0.02) and fQRS in inferior ECG leads in patients with QRS duration of less than 120 ms (OR, 4.88; 95% CI, 1.18–20; P= 0.03)—remained significant in the multivariable analysis. Total mortality was associated with morbidity but not with fQRS. conclusions Fragmented QRS in inferior ECG leads in patients with QRS duration <120 ms is an independent parameter associated with AE in patients with ICD. Whether it could be helpful in deciding to perform early / prophylactic ablation in these patients needs to be prospectively studied.