Fragmented ECG as a Risk Marker in Cardiovascular Diseases

Various noninvasive tests for risk stratification of sudden cardiac death (SCD) were studied, mostly in the context of structural heart disease such as coronary artery disease (CAD), cardiomyopathy and heart failure but have low positive predictive value for SCD. Fragmented QRS complexes (fQRS) on a 12-lead ECG is a marker of depolarization abnormality. fQRS include presence of various morphologies of the QRS wave with or without a Q wave and includes the presence of an additional R wave (R’) or notching in the nadir of the R’ (fragmentation) in two contiguous leads, corresponding to a major coronary artery territory. fQRS represents conduction delay from inhomogeneous activation of the ventricles due to myocardial scar. It has a high predictive value for myocardial scar and mortality in patients CAD. fQRS also predicts arrhythmic events and mortality in patients with implantable cardioverter defibrillator. It also signifies poor prognosis in patients with nonischemic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and Brugada syndrome. However, fQRS is a nonspecific finding and its diagnostic prognostic should only be interpreted in the presence of pertinent clinical evidence and type of myocardial involvement (structural vs. structurally normal heart).     

Fragmented QRS complex in patients with implantable cardioverter defibrillator—Prevalence and predisposing factors

Background

Incidence of fragmented (fQRS) and predisposing factors in patients with implantable cardioverter-defibrillator (ICD) have not yet been established.AimTo examine incidence of fQRS, associated factors as well as predictive value in identifying site of coronary artery disease (CAD).

碎裂QRS波对冠心病心肌缺血的预测价值

目的探讨心电图中的碎裂QRS波(Fragmented QRS,fQRS)对冠心病心肌缺血的预测价值。方法回顾性分析2012年1月~2013年12月在包头市中心医院心内科住院的临床上考虑冠心病并进行过选择性冠状动脉造影(CAG)检查的患者病例492份。根据患者入院以后前三日内心电图中有无碎裂QRS(fQRS)波分为两组,其中A组(有fQRS波)271例,B组(无fQRS波)221例。首先比较两组患者的一般临床资料(包括年龄、性别,合并症有无高血压、糖尿病、高脂血症),然后比较两组患者的血管狭窄程度有无差异。结果 (1)AB两组患者的一般临床资料差异均无统计学意义(P≥0.05)。(2)AB两组患者的冠脉血管狭窄程度不同,差异具有统计学意义(P0.05),A组的冠心病心肌缺血患病率高于B组,差异具有统计学意义(P0.05)。结论碎裂QRS波对冠心病心肌缺血的发生有较高的预测价值。     

肥厚型心肌病合并心房颤动患者射频消融术后心律失常复发心电指标的预测

目的:探讨心电指标f QRS与QTc联合是否能更好预测肥厚型心肌病(HCM)合并心房颤动患者导管消融术后的复发。方法:纳入在北京安贞医院行导管消融术的HCM合并心房颤动患者共120例(阵发/持续性心房颤动72/48)。消融策略包括:阵发性心房颤动患者行双侧肺静脉隔离(PVI);持续性心房颤动患者行PVI加左心房顶、二尖瓣峡部和三尖瓣峡部线性消融。术前评估基线心电图,f QRS定义为常规12导联心电图中至少两个连续导联的QRS波存在≥2个R波或者R波的波顶或S波的波谷出现顿挫波。采用Bazett公式校正QT间期。术后定期随访,复发定义为导管消融术后心电图或动态心电图记录的任何类型的>30 s的房性快速性心律失常。结果:59.2%(71/120)患者f QRR阳性。f QRS最常见于下壁导联(81.7%)。QTc间期(443.90±38.59)ms。平均随访13.4个月,窦性心律维持率为42.5%。多因素Cox回归分析表明,f QRS阳性(HR=1.922,95%CI:1.151~3.210,P=0.012)和QTc>448 ms(HR=1.982,95%CI 1.155~3.402,P=0.013)分别是术后复发的危险因素。f QRS和QTc联合能更好预测心房颤动术后复发。结论:f QRS和QTc延长是HCM合并心房颤动患者导管消融术后复发的独立预测因素。f QRS和QTc联合可用于预测该类患者心房颤动射频术后转归。     

心电图碎裂QRS波与高血压患者左心室舒张功能的相关性研究

目的:本文拟探索心电图碎裂QRS波与高血压患者左心室舒张功能障碍之间的相关性。方法:前瞻性分析冠状动脉造影正常的102例原发性高血压患者资料。碎裂QRS波群定义为至少两个相关导联QRS波群(<120 ms)呈RSR'型(≥1个R'波、或S波、R波存在切迹),并无典型束支传导阻滞的心电图图形。所有患者经超声心动图检查并记录左心室舒张功能。左心室舒张功能不全分为两型:非严重型(1级舒张功能不全)和严重型(≥2级舒张功能不全)。结果:52例患者出现碎裂QRS波,为碎裂QRS波阳性组,50例无碎裂QRS波,为碎裂QRS波阴性组。两组基线情况基本相同。碎裂QRS波阳性组出现严重舒张功能不全比例明显高于碎裂QRS波阴性组(P<0.05)。碎裂QRS波阳性组高血压病程明显长于碎裂QRS波阴性组(P<0.05)。心电图中碎裂QRS波是左心室重度舒张期功能障碍的指标(OR=9.2;95%CI=3.4~31.4;P=0.009)。结论:心电图碎裂QRS波的存在可提示高血压患者左心室舒张功能严重不全。     

The Management of a patient with a fragmented intrauterine device embedded within the cervical canal

A 28-year-old woman presented with a malpositioned intrauterine device (IUD) that was fragmented and significantly entrenched within the cervical canal and myometrium. IUD malposition with concomitant device fragmentation and embedded segments, albeit rare, should be a consideration given the device's prevalence.     

心电图碎片状QRS波群与心血管事件发生的相关性研究

目的探讨心电图碎片状QRS复合波（fQRs）与心血管事件发生的相关性。方法随机抽取1000份我院心血管内科住院患者的12导联平静心电图,排除存在束支传导阻滞或起搏心律者,剩余939份心电图对应的939例患者为研究对象,按照心电图中是否存在fQRs波分成2组,研究两组患者在性别、年龄、心血管事件发生率等方面差异是否具有统计学意义。结果心电图出现fQRs波组患者冠心病、心肌缺血的总发生率为19．6％,心肌梗死总发生率为10．5％,左心室肥厚发生率为34．7％,相对正常者占35．2％;心电图无fORs波出现组患者冠心病、心肌缺血的总发生率为8．2％,心肌梗死发生率为6．5％,左心室肥厚发生率为12．9％,相对正常者占72．4％。经两样本x2检验,P〈0．01,两组心血管事件发生情况差异有统计学意义。结论心电图中出现fQRs波患者心血管事件的发生率较心电图无fQRs波改变者显著升高（P〈0．01）。碎片状QRS波群的出现能在一定程度上提示心血管事件的发生。