Prevalence and Prognostic Significance of Fragmented QRS Complex in Middle-Aged Subjects With and Without Clinical or Electrocardiographic Evidence of Cardiac Disease

• Published in: The American journal of cardiology Vol. 114; no. 1; pp. 141 - 147
• Main Authors: Terho, Henri K., Tikkanen, Jani T., Junttila, Juhani M., Anttonen, Olli, Kenttä, Tuomas V., Aro, Aapo L., Kerola, Tuomas, Rissanen, Harri A., Reunanen, Antti, Huikuri, Heikki V.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2014; Elsevier Limited
• Subjects: Adult; Blood pressure; Body mass index; Cardiovascular; Cardiovascular disease; Colonies & territories; Confidence intervals; Electrocardiography; Female; Finland - epidemiology; Heart; Heart attacks; Heart Conduction System - physiopathology; Heart Diseases - diagnosis; Heart Diseases - epidemiology; Heart Diseases - physiopathology; Humans; Male; Medical prognosis; Middle age; Middle Aged; Population; Prevalence; Prognosis; Studies; Variables; Finland
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2014.03.066

We wanted to evaluate the prevalence and prognostic value of the fragmented QRS (fQRS) complex, defined as changes in QRS morphology with various RSR′-patterns in 12-lead electrocardiogram (ECG) in a middle-aged general population. We evaluated the 12-lead ECGs of 10,904 Finnish middle-aged subjects (52% men, mean age 44 ± 8.5 years) with (n = 2,543) and without (n = 8,361) an evidence of cardiac disease drawn from general population and followed them for 30 ± 11 years. Fragmentation of the QRS complex was defined as various RSR′-patterns in at least 2 consecutive leads within the same territory (inferior II, III, aVF; lateral I, aVL, V4 to V6; anterior V1 to V3). Primary end points were death from any cause, cardiac, and arrhythmic deaths. In the total population, fQRS was present in 19.7% (n = 2,147) of subjects, including 15.7% (n = 1714) in inferior leads, 0.8% (n = 84) in lateral leads, and 2.9% (n = 314) in anterior leads. Fragmentation was not associated with increased mortality in subjects without a known cardiac disease. However, fQRS observed in lateral leads in subjects with an evidence of cardiac disease was associated with an increased risk of all-cause (p = 0.001), cardiac (p = 0.001), and arrhythmic (p = 0.004) mortalities. In conclusion, fQRS reflecting minor intraventricular conduction defect is a common finding, especially in the inferior leads, but it is not a sign of increased risk of mortality in subjects without a known cardiac disease. Lateral fQRS, which is less commonly observed in the ECG, is associated with a worse outcome in patients with a known cardiac disease.