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QRS fragmentation in standard ECG as a diagnostic marker of arrhythmogenic right ventricular dysplasia–cardiomyopathy
Abstract
Background Epsilon potentials in right precordial leads are reliable diagnostic electrocardiographic (ECG) criteria of arrhythmogenic right ventricular dysplasia-cardiomyopathy (ARVD/C). Sensitivity of epsilon potentials can be enhanced by highly amplified and modified ECG recording technique. Nevertheless, in many cases the definition of epsilon potentials remains difficult.Objective To overcome these limitations, the value of QRS fragmentation in a standard 12-lead ECG was analyzed in 360 patients with ARVD/C (176 men, mean age 47.3 +/- 13.7 years).Methods Analysis of QRS fragmentation of the whole collective of patients was compared with the detection of epsilon potentials in highly amplified right precordial and modified limb leads in a subgroup of 207 patients. Fifty-two phenotypically and genotypically nonaffected subjects from systematic family screening in 10 families with known plakophilin-2 and desmoplakin mutations served as a control group.Results QRS fragmentation could be found in a total of 306 of 360 patients (85%); 2.09 +/- 1.8 fragmented QRS complexes (range 1 to 7) could be found per patient. Fragmented QRS complexes in only 1 right precordial lead were found in 106 cases. In 190 cases, QRS fragmentation was present in more than 1 lead, including all 12 standard leads. Epsilon potentials in highly amplified right precordial and modified limb leads could be found in a total of 159 cases (77%). Typical epsilon potentials in highly amplified right precordial leads could be found in 97 cases (47%).Conclusion QRS fragmentation in ARVD/C has a high diagnostic value similar to epsilon potentials by a highly amplified and modified recording technique.
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“QRS fragmentation in patients with arrhythmogenic right ventricular dysplasia was shown to have a high diagnostic value similar to epsilon potentials by a highly amplified and modified recording technique.48”
From The Year of 2008 in Electrocardiology (2010) · cites this paper as [48]
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Significance of a Fragmented QRS Complex Versus a Q Wave in Patients With Coronary Artery Disease
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Nasir, K., Bomma, C. S., Tandri, H. S., Roguin, A., Dalal, D., Prakasa, K., Tichnell, C., James, C. A., Jspevak, P., Marcus, G. M., et al. (2004) · Circulation · doi:10.1161/01.cir.0000142293.60725.18 · Cited by 292
Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy: A Review
Marcus, G. M., & Fontaine, G. H. (1995) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.1995.tb06971.x · Cited by 255
Fontaine, G. H. (1977) · Medical Entomology and Zoology · Cited by 232
Cox, M. G. P. J., Nelen, M. R., Wilde, A. A. M., Wiesfeld, A. C. P., JASPER, J. S., Loh, P. K. K., Cramer, M. J., Doevendans, P. A., van Tintelen, J. P., de Bakker, J. M. T., et al. (2008) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2008.01140.x · Cited by 111
Peters, S., & Trümmel, M. (2003) · Annals of Noninvasive Electrocardiology · doi:10.1046/j.1542-474x.2003.08312.x · Cited by 106
Self-citationAdvances in the diagnostic management of arrhythmogenic right ventricular dysplasia–cardiomyopathy
Peters, S. (2006) · International Journal of Cardiology · doi:10.1016/j.ijcard.2005.12.015 · Cited by 55
Self-citationPeters, S., Trümmel, M., Koehler, B., & Westermann, K. U. (2006) · Journal of Electrocardiology · doi:10.1016/j.jelectrocard.2006.10.002 · Cited by 49
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- Zhang, 2006, Are epsilon waves in ARVD “the right precordial leads only” phenomena, Europace, 8
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J Wave Syndromes Consensus Conference: Emerging Concepts & Gaps in Knowledge
Antzelevitch, C., Yan, G.-X., Ackerman, M., Borggrefe, M., Corrado, D., Guo, J.-H., Gussak, I., Hasdemir, C., Horie, M., Huikuri, H., et al. (2016) · Heart Rhythm · doi:10.1016/j.hrthm.2016.05.024 · Cited by 239
Das, M. K., Maskoun, W., Shen, C., Michael, M. A., Suradi, H. S., Desai, M., Subbarao, R., & Bhakta, D. (2009) · Heart Rhythm · doi:10.1016/j.hrthm.2009.09.065 · Cited by 279
Gandjbakhch, E., Redheuil, A. B., Pousset, F., Charron, P., & Frank, R. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.05.065 · Cited by 272
Fragmented QRS: A predictor of mortality and sudden cardiac death
Das, M. K., & Zipes, D. P. (2008) · Heart Rhythm · doi:10.1016/j.hrthm.2008.10.019 · Cited by 241
J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge.
Antzelevitch, C., Yan, G.-X., Ackerman, M., Borggrefe, M., Corrado, D., Guo, J.-H., Gussak, I., Hasdemir, C., Horie, M., Huikuri, H., et al. (2016) · Europace · doi:10.1093/europace/euw235 · Cited by 155
Metadata
- Authors
- Peters, S., Trümmel, M., & Koehler, B.
- Corresponding author
- Peters, Stefan
- ORCID
- Peters, Stefan
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2008-10
- Volume
- 5
- Issue
- 10
- Pages
- 1417-1421
- ISSN
- 1547-5271 (ISSN-L)
- OpenAlex
- W1963847400
- Cited by
- 155
- References
- 9
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 4 · 2023: 7 · 2022: 8 · 2021: 7 · 2020: 6 · 2019: 3 · 2018: 9 · 2017: 9 · 2016: 11 · 2015: 15 · 2014: 21 · 2013: 15 · 2012: 18
- FWCI
- 4.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart Rhythm (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Keywords
- QRS fragmentation, arrhythmogenic right ventricular cardiomyopathy, electrocardiographic diagnosis, right precordial leads, family screening
- MeSH terms
- Adult, Electrocardiography, Female, Humans, Male, Middle Aged, Biomarkers, Arrhythmogenic Right Ventricular Dysplasia
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