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The Association Between Fragmeted QRS and ICD Shocks in patients with Left Ventricular Systolic Heart Failure

Year 2013, Volume: 2 Issue: 1, 7 - 11, 01.01.2013
https://doi.org/10.5505/abantmedj.2013.25733

Abstract

OBJECTIVE: The relationship between fragmented QRS fQRS and mortality, ventricular arrhythmias in patients left ventricular systolic dysfunction has been studied and the results have been conflicting. In our study, we aimed to find the association between implantable cardioverter defibrillator ICD shocks and fQRS in patients who had functional capacity below 3and was not on antiarrhyhtmic drugs.METHODS: We consecutively included 156 systolic heart failure patients who applied to our clinic for routine clinic follow up. All patients had been implanted ICD for more than 1 year. All ICDs were interrogated for arrhythmic episodes. Patients were divided into two groups according to presence of fQRS. RESULTS: Patients in fQRS group had more shock events p: 0.001 . After regression analyze carried out fQRS was found to be predictor of shock events both for univariable OR: 8.2 3.8-9.8 , p>0.001 and multivariable analyzes OR: 3.8 2.1-7.9 , p>0.001 . CONCLUSION: fQRS predicted shock events in patients who had functional capacity below 3 and were not on antiarrhythmic therapy. The tendency for arrhythmic events seems as an important finding for this group of patients for clinical approach.

References

  • Mahenthiran J, Khan BR, Sawada SG, Das MK.Fragmented QRS complexes not typical of a bund- le branch block: a marker of greater myocardial per- fusion tomography abnormalities in coronary artery disease. J Nucl Cardiol. 2007 May-Jun;14(3):347-53.
  • Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J.Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Cir- culation. 2006 May 30;113(21):2495-501.
  • Basaran Y, Tigen K, Karaahmet T, Isiklar I, Cevik C, Gurel E, Dundar C, Pala S, Mahmutyazicioglu K, Basa- ran O. Fragmented QRS complexes are associated with cardiac fibrosis and significant intraventricular systolic dyssynchrony in nonischemic dilated cardi- omyopathy patients with a narrow QRS interval. Ec- hocardiography. 2011 Jan;28(1):62-8.
  • Das MK, Suradi H, Maskoun W, Michael MA, Shen C, Peng J, Dan-damudi G, Mahenthiran J. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythm Electrophysiol. 2008;1:258 –268.
  • Park SJ, On YK, Kim JS, Park SW, Yang JH, Jun TG, Kang IS, Lee HJ, Choe YH, Huh J.Relation of fragmented QRS complex to right ventricular fibrosis detected by late gadolinium enhancement cardiac magnetic resonance in adults with repaired tetralogy of fallot. Am J Car- diol. 2012 Jan 1;109(1):110-5.
  • Das MK, Saha C, El Masry H, et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm 2007; 4:1385 – 1392.
  • Pietrasik G, Goldenbe rg I, Zdzienicka J, et al. Progno stic signiŞcance of fragmented QRS comp lex for pre- dicting the risk of recurrent cardiac events in patients with Q-wave myocardial infarction. Am J Cardio l 2007; 100:583 – 586
  • 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;7:74-80.
  • Cheema A, Khalid A, Wimmer A, Bartone C, Chow T, Spertus JA, Chan PS.Fragmented QRS and mortality risk in patients with left ventricular dysfunction.Circ Arrhythm Electrophysiol. 2010 Aug;3(4):339-44.
  • Forleo GB, Della Rocca DG, Papavasileiou LP, Panatto- ni G, Sergi D, Duro L, Mahfouz K, Magliano G, Santini L, Romeo F.Predictive value of fragmented QRS in primary prevention implantable cardioverter defibril- lator recipients with left ventricular dysfunction.J Cardiovasc Med (Hagerstown). 2011;12:779-84.
  • Michael M, Das M. Fragmented QRS (fQRS) on 12- lead EKG is a predictor of arrhythmic events and mor- tality in patients with dilated cardiomyopathy. Heart Rhythm 2006;3 Suppl:S103
  • Sha J, Zhang S, Tang M, Chen K, Zhao X, Wang F. Fragmented QRS is associated with all-cause mortality and ventricular arrhythmias in patient with idiopathic dilated cardiomyopathy. Ann Noninvasive Electrocar- diol. 2011 Jul;16(3):270-5.
  • Maskoun W, Suradi H, Mahenthiran J, Das m. Frag- mented QRS complexes on a 12-lead ECG predict arrhythmic events in patients with ischemic cardiom- yop-athy who receive an ICD for primary prophylaxis. Heart Rhythm 2007;4:S211–212.
  • Varriale P, Chryssos BE. The RSR = complex not rela- ted to right bundle branch block: diagnostic value as a sign of myocardial infarction scar. Am Heart J 1992;123:369 –376.
  • Flowers NC, Horan LG, Thomas JR, Tolleson WJ. The anatomic basis for high-frequency components in the electrocardiogram. Circulation 1969;39:531–539.
  • Homsi M, Alsayed L, Das MK, Mahenthiran J. Frag- mented QRS complexes on a 12-lead ECG is a marker of greater myocardial scarring related to coronary ar- tery disease by magnetic resonance imaging. J Am Coll Cardiol 2008;51:A31.
  • Homsi M, Alsayed L, Das MK, Mahenthiran J. Frag- mented QRS complexes on a 12-lead ecg is a marker of greater myocardial scarringd related to non- coronary artery diseases by magnetic resonance ima- ging. J Am Coll Cardiol 2009;53:A140.
  • Homsi M, Alsayed L, Safadi B, Mahenthiran J, Das MK. Fragmented QRS complexes on 12-lead ECG: a marker of cardiac sarcoidosis as detected by gadolinium car- diac magnetic resonance imaging.Ann Noninvasive Electrocardiol. 2009 Oct;14(4):319-26.
  • Stevenson WG, Soejima K. Catheter ablation for vent- ricular tachycardia. Cir-culation 2007;115:2750 – 2760.
  • Wiener I, Mindich B, Pitchon R. Fragmented endocar- dial electrical activity in patients with ventricular tachycardia: a new guide to surgical therapy. Am He- art J 1984;107:86 –90.
  • de Bakker JM, van Capelle FJ, Janse MJ, et al. Slow conduction in the infracted human heart. “Zigzag” course of activation. Circulation 1993;88:915–926.
  • Alim Erdem, Mehmet Yazıcı. The cardiac electrophy- siologic study. Abant Med J. 2012; 1: 99-103

Sistolik Sol Kalp Yetmezliği Olan Hastalarda Fragmante QRS ile ICD şokları arasındaki ilişki

Year 2013, Volume: 2 Issue: 1, 7 - 11, 01.01.2013
https://doi.org/10.5505/abantmedj.2013.25733

Abstract

AMAÇ: Sol ventrikül sistolik disfonksiyonu olan hastalarda fragmente QRS’in fQRS mortalite ve ventriküler aritmi ile ilişkisine dair farklı bilgiler mevcuttur. Biz çalışmamızda fQRS’in fonksiyonel kapasitesi 3 altında olan ve herhangi antiaritmik ilaç kullanmayan implante edilebilir şok cihazı ICD taşıyan hasta grubundaki yaşanmış şok olayları ile ilişkisini saptamak istedik. YÖNTEMLER: Çalışmamız 1 yılı aşkın süredir ICD implante edilmiş fonksiyonel kapasitesi 3 altında olan ve herhangi antiaritmik ilaç kullanmayan rutin klinik kontrollere gelen 156 sistolik kalp yetmezliği hastasını kapsamaktadır. Tüm hastaların ICD kontrolleri daha önceden yaşamış oldukları artimik olaylar için yapılmıştır. Hastalar fQRS varlığına göre ikiye ayrılıp analizler yapılmıştır.BULGULAR: Fragmantasyon olan ve olmayan grup karşılaştırıldığı zaman fragmantasyon olan grupta anlamlı düzeyde şok olayı vardı p: 0.001 . Regresyon analizi yapıldığında fragmantsyon varlığının hem şoku predikte ettiği hem tek Odds oranı: 8.2 3.8-9.8 , p>0.001 hem de çok değişkenli analiz regresyon analizi ile saptanmıştır Odds oranı: 3.8 2.1-7.9 , p>0.001 . SONUÇ: Fonksiyonel kapasitesi 3 altında olan ve herhangi antiaritmik ilaç kullanmayan hastalarda fQRS varlığı cihaza bağlı şok olaylarını predikte etmektedir. Bu bulgu fQRS’in bu grup hastalarda aritmik olaylara yatkınlığı göstermesi klinik yaklaşım açısından önemli gözükmektedir.

References

  • Mahenthiran J, Khan BR, Sawada SG, Das MK.Fragmented QRS complexes not typical of a bund- le branch block: a marker of greater myocardial per- fusion tomography abnormalities in coronary artery disease. J Nucl Cardiol. 2007 May-Jun;14(3):347-53.
  • Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J.Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Cir- culation. 2006 May 30;113(21):2495-501.
  • Basaran Y, Tigen K, Karaahmet T, Isiklar I, Cevik C, Gurel E, Dundar C, Pala S, Mahmutyazicioglu K, Basa- ran O. Fragmented QRS complexes are associated with cardiac fibrosis and significant intraventricular systolic dyssynchrony in nonischemic dilated cardi- omyopathy patients with a narrow QRS interval. Ec- hocardiography. 2011 Jan;28(1):62-8.
  • Das MK, Suradi H, Maskoun W, Michael MA, Shen C, Peng J, Dan-damudi G, Mahenthiran J. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythm Electrophysiol. 2008;1:258 –268.
  • Park SJ, On YK, Kim JS, Park SW, Yang JH, Jun TG, Kang IS, Lee HJ, Choe YH, Huh J.Relation of fragmented QRS complex to right ventricular fibrosis detected by late gadolinium enhancement cardiac magnetic resonance in adults with repaired tetralogy of fallot. Am J Car- diol. 2012 Jan 1;109(1):110-5.
  • Das MK, Saha C, El Masry H, et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm 2007; 4:1385 – 1392.
  • Pietrasik G, Goldenbe rg I, Zdzienicka J, et al. Progno stic signiŞcance of fragmented QRS comp lex for pre- dicting the risk of recurrent cardiac events in patients with Q-wave myocardial infarction. Am J Cardio l 2007; 100:583 – 586
  • 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;7:74-80.
  • Cheema A, Khalid A, Wimmer A, Bartone C, Chow T, Spertus JA, Chan PS.Fragmented QRS and mortality risk in patients with left ventricular dysfunction.Circ Arrhythm Electrophysiol. 2010 Aug;3(4):339-44.
  • Forleo GB, Della Rocca DG, Papavasileiou LP, Panatto- ni G, Sergi D, Duro L, Mahfouz K, Magliano G, Santini L, Romeo F.Predictive value of fragmented QRS in primary prevention implantable cardioverter defibril- lator recipients with left ventricular dysfunction.J Cardiovasc Med (Hagerstown). 2011;12:779-84.
  • Michael M, Das M. Fragmented QRS (fQRS) on 12- lead EKG is a predictor of arrhythmic events and mor- tality in patients with dilated cardiomyopathy. Heart Rhythm 2006;3 Suppl:S103
  • Sha J, Zhang S, Tang M, Chen K, Zhao X, Wang F. Fragmented QRS is associated with all-cause mortality and ventricular arrhythmias in patient with idiopathic dilated cardiomyopathy. Ann Noninvasive Electrocar- diol. 2011 Jul;16(3):270-5.
  • Maskoun W, Suradi H, Mahenthiran J, Das m. Frag- mented QRS complexes on a 12-lead ECG predict arrhythmic events in patients with ischemic cardiom- yop-athy who receive an ICD for primary prophylaxis. Heart Rhythm 2007;4:S211–212.
  • Varriale P, Chryssos BE. The RSR = complex not rela- ted to right bundle branch block: diagnostic value as a sign of myocardial infarction scar. Am Heart J 1992;123:369 –376.
  • Flowers NC, Horan LG, Thomas JR, Tolleson WJ. The anatomic basis for high-frequency components in the electrocardiogram. Circulation 1969;39:531–539.
  • Homsi M, Alsayed L, Das MK, Mahenthiran J. Frag- mented QRS complexes on a 12-lead ECG is a marker of greater myocardial scarring related to coronary ar- tery disease by magnetic resonance imaging. J Am Coll Cardiol 2008;51:A31.
  • Homsi M, Alsayed L, Das MK, Mahenthiran J. Frag- mented QRS complexes on a 12-lead ecg is a marker of greater myocardial scarringd related to non- coronary artery diseases by magnetic resonance ima- ging. J Am Coll Cardiol 2009;53:A140.
  • Homsi M, Alsayed L, Safadi B, Mahenthiran J, Das MK. Fragmented QRS complexes on 12-lead ECG: a marker of cardiac sarcoidosis as detected by gadolinium car- diac magnetic resonance imaging.Ann Noninvasive Electrocardiol. 2009 Oct;14(4):319-26.
  • Stevenson WG, Soejima K. Catheter ablation for vent- ricular tachycardia. Cir-culation 2007;115:2750 – 2760.
  • Wiener I, Mindich B, Pitchon R. Fragmented endocar- dial electrical activity in patients with ventricular tachycardia: a new guide to surgical therapy. Am He- art J 1984;107:86 –90.
  • de Bakker JM, van Capelle FJ, Janse MJ, et al. Slow conduction in the infracted human heart. “Zigzag” course of activation. Circulation 1993;88:915–926.
  • Alim Erdem, Mehmet Yazıcı. The cardiac electrophy- siologic study. Abant Med J. 2012; 1: 99-103
There are 22 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Fırat Özcan This is me

Osman Turak This is me

Derya Tok This is me

Sedat Avcı This is me

İskender Kadife This is me

Ahmet İşleyen This is me

Muhammed Cebeci This is me

Fatma Nurcan Başar This is me

Kumral Çağlı This is me

Serkan Topaloğlu This is me

Dursun Aras This is me

Sinan Aydoğdu This is me

Publication Date January 1, 2013
Published in Issue Year 2013 Volume: 2 Issue: 1

Cite

APA Özcan, F., Turak, O., Tok, D., Avcı, S., et al. (2013). Sistolik Sol Kalp Yetmezliği Olan Hastalarda Fragmante QRS ile ICD şokları arasındaki ilişki. Abant Medical Journal, 2(1), 7-11. https://doi.org/10.5505/abantmedj.2013.25733
AMA Özcan F, Turak O, Tok D, Avcı S, Kadife İ, İşleyen A, Cebeci M, Başar FN, Çağlı K, Topaloğlu S, Aras D, Aydoğdu S. Sistolik Sol Kalp Yetmezliği Olan Hastalarda Fragmante QRS ile ICD şokları arasındaki ilişki. Abant Med J. January 2013;2(1):7-11. doi:10.5505/abantmedj.2013.25733
Chicago Özcan, Fırat, Osman Turak, Derya Tok, Sedat Avcı, İskender Kadife, Ahmet İşleyen, Muhammed Cebeci, Fatma Nurcan Başar, Kumral Çağlı, Serkan Topaloğlu, Dursun Aras, and Sinan Aydoğdu. “Sistolik Sol Kalp Yetmezliği Olan Hastalarda Fragmante QRS Ile ICD şokları arasındaki ilişki”. Abant Medical Journal 2, no. 1 (January 2013): 7-11. https://doi.org/10.5505/abantmedj.2013.25733.
EndNote Özcan F, Turak O, Tok D, Avcı S, Kadife İ, İşleyen A, Cebeci M, Başar FN, Çağlı K, Topaloğlu S, Aras D, Aydoğdu S (January 1, 2013) Sistolik Sol Kalp Yetmezliği Olan Hastalarda Fragmante QRS ile ICD şokları arasındaki ilişki. Abant Medical Journal 2 1 7–11.
IEEE F. Özcan, “Sistolik Sol Kalp Yetmezliği Olan Hastalarda Fragmante QRS ile ICD şokları arasındaki ilişki”, Abant Med J, vol. 2, no. 1, pp. 7–11, 2013, doi: 10.5505/abantmedj.2013.25733.
ISNAD Özcan, Fırat et al. “Sistolik Sol Kalp Yetmezliği Olan Hastalarda Fragmante QRS Ile ICD şokları arasındaki ilişki”. Abant Medical Journal 2/1 (January 2013), 7-11. https://doi.org/10.5505/abantmedj.2013.25733.
JAMA Özcan F, Turak O, Tok D, Avcı S, Kadife İ, İşleyen A, Cebeci M, Başar FN, Çağlı K, Topaloğlu S, Aras D, Aydoğdu S. Sistolik Sol Kalp Yetmezliği Olan Hastalarda Fragmante QRS ile ICD şokları arasındaki ilişki. Abant Med J. 2013;2:7–11.
MLA Özcan, Fırat et al. “Sistolik Sol Kalp Yetmezliği Olan Hastalarda Fragmante QRS Ile ICD şokları arasındaki ilişki”. Abant Medical Journal, vol. 2, no. 1, 2013, pp. 7-11, doi:10.5505/abantmedj.2013.25733.
Vancouver Özcan F, Turak O, Tok D, Avcı S, Kadife İ, İşleyen A, Cebeci M, Başar FN, Çağlı K, Topaloğlu S, Aras D, Aydoğdu S. Sistolik Sol Kalp Yetmezliği Olan Hastalarda Fragmante QRS ile ICD şokları arasındaki ilişki. Abant Med J. 2013;2(1):7-11.