New Appearance of Fragmented QRS as a Predictor of Ventricular Arrhythmic Events in Patients With Hypertrophic Cardiomyopathy.
BACKGROUND
Multiple spikes in the QRS complex (fragmented QRS [fQRS]) on 12-lead electrocardiography have been associated with ventricular arrhythmic events (VAEs) in patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to assess the association between new appearances of fQRS and cardiac events in patients with HCM.Methods and Results:The association between baseline fQRS and cardiac events, namely VAEs, heart failure-related hospitalization, and all-cause death, was evaluated retrospectively in 146 HCM patients (46 patients with fQRS, 100 without fQRS). The median follow-up was 5.3 years. Cardiac events occurred in 29 patients with baseline fQRS and 32 patients without baseline fQRS (63% vs. 32%; P<0.001). VAEs occurred in a significantly larger percentage of patients with than without baseline fQRS (54% vs. 23%, respectively; P<0.001). Of the 100 patients without baseline fQRS, 33 had a new appearance of fQRS during the 4.6-year follow-up, whereas 67 did not. VAEs occurred more frequently in the 33 patients with the appearance of fQRS than in those without (42% vs. 13%, respectively; P=0.001). Multivariable analysis showed that the new appearance of fQRS documented before VAEs was associated with VAEs (hazard ratio 4.29, 95% confidence interval 1.81-10.2; P=0.001).


CONCLUSIONS
The new appearance of fQRS was associated with an increased risk of VAEs in HCM patients.
['Ogura|Soichiro|S|', 'Nakamura|Kazufumi|K|', 'Morita|Hiroshi|H|', 'Toh|Norihisa|N|', 'Nakagawa|Koji|K|', 'Yoshida|Masashi|M|', 'Watanabe|Atsuyuki|A|', 'Nishii|Nobuhiro|N|', 'Miyoshi|Toru|T|', 'Ito|Hiroshi|H|']
D000200:Action Potentials D000328:Adult D000368:Aged D001145:Arrhythmias, Cardiac D002312:Cardiomyopathy, Hypertrophic D002423:Cause of Death D004562:Electrocardiography D005260:Female D006329:Heart Conduction System D006333:Heart Failure D006339:Heart Rate D006760:Hospitalization D006801:Humans D008297:Male D008875:Middle Aged D011237:Predictive Value of Tests D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors
Fragmented QRS Hypertrophic cardiomyopathy Electrocardiography Hospitalization Ventricular arrhythmia