Published Online
on July 14, 2008

A more recent version of this article appeared on October 1, 2008

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Original Article

Fragmented Wide QRS on a 12-Lead ECG: A Sign of Myocardial Scar and Poor Prognosis

Mithilesh K. Das^1,3; Hussam Suradi¹; Waddah Maskoun¹; Jonathan Peng¹; Mark A. Michael¹; Changyu Shen²; Gopi Dandamudi¹ and Jo Mahenthiran¹

¹ Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN;
² Division of Biostatistics, Indiana University School of Medicine, Indianapolis, IN

³ E-mail: midas{at}iupui.edu

Background—Fragmented QRS (fQRS, duration <120 ms) on a 12-lead ECG represents myocardial scar in patients with coronary artery disease (CAD). However, the significance of fQRS has not been defined in the presence of a wide QRS (wQRS, duration 120 ms). We postulate that fragmented wQRS (f-wQRS) due to bundle branch block (f-BBB); premature ventricular complexes (f-PVC) or paced rhythms (f-pQRS) signify myocardial scar and higher mortality.

Methods and Results—Patients who underwent cardiac evaluation with nuclear stress imaging or cardiac catheterization and had wQRS (BBB, PVC or pQRS) were studied. f-wQRS was defined by the presence of >2 notches on the R wave or the S wave, and had to be present in >2 contiguous inferior (II, III, aVF), lateral (I, aVL, V₆) or anterior (V₁-V₅) leads. ECG analyses of 879 patients (age 66.7±11.4 years, male: 97%, mean follow-up 29±18 months) with BBB (n=310), PVC (n=301) and pQRS (n=268) revealed f-wQRS in 415 (47.2%) patients. Myocardial scar was present in 440 (50%) patients. The sensitivity, specificity, positive predictive value and negative predictive value of f-wQRS for myocardial scar were 86.8%, 92.5%, 92.0% and 87.5%, respectively. The sensitivity and specificity for diagnosing myocardial scar were 88.6% and 94.4%, 81.4% and 88.4% and, 89.8% and 95.7%, for f-BBB, f-PVC and f-pQRS, respectively. f-wQRS was associated with mortality after adjusting for age, ejection fraction and diabetes (p=0.017).

Conclusions—f-wQRS on a standard 12-lead ECG is a moderately sensitive and highly specific sign for myocardial scar in patients with known or suspected CAD. f-wQRS is also an independent predictor of mortality.

Key Words: coronary disease • electrocardiography • scintigraphy • fragmented QRS • myocardial scar

Related Article

Fragmented Wide QRS on a 12-Lead ECG: A Sign of Myocardial Scar and Poor Prognosis

Mithilesh K. Das, Hussam Suradi, Waddah Maskoun, Mark A. Michael, Changyu Shen, Jonathan Peng, Gopi Dandamudi, and Jo Mahenthiran
Circ Arrhythm Electrophysiol 2008 1: 258-268. [Abstract] [Full Text] [PDF]