Fragmented Wide QRS on a 12-Lead ECG: A Sign of Myocardial Scar and Poor Prognosis
Abstract
Background— Fragmented QRS (duration <120 ms) on a 12-lead ECG represents myocardial scar in patients with coronary artery disease. However, the significance of fragmented QRS 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, premature ventricular complexes, 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 (bundle branch block, premature ventricular complex, 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, V 6 ) or anterior (V 1 to V 5 ) leads. ECG analyses of 879 patients (age, 66.7�11.4 years; male, 97%; mean follow-up, 29�18 months) with bundle branch block (n=310), premature ventricular complex (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-bundle branch block, f-premature ventricular complex, 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 coronary artery disease. f-wQRS is also an independent predictor of mortality.
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A fragmented wide QRS is a sign of myocardial scar and an independent predictor of mortality.
“A fragmented wide QRS was found to be a sign of myocardial scar and an independent predictor of mortality in the investigation of Das and coworkers 47”
From The Year of 2008 in Electrocardiology (2010) · cites this paper as [47]
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- Authors
- Das, M. K., Suradi, H., Maskoun, W., Michael, M. A., Shen, C., Peng, J., Dandamudi, G., & Mahenthiran, J.
- Affiliations
- Indiana University Indianapolis (US)
- Venue
- Circulation: Arrhythmia and Electrophysiology
- Published
- 2008-10
- Volume
- 1
- Issue
- 4
- Pages
- 258-268
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2107103201
- Cited by
- 362
- References
- 35
- Citations by year
- 2026: 12 · 2025: 16 · 2024: 21 · 2023: 7 · 2022: 20 · 2021: 26 · 2020: 24 · 2019: 32 · 2018: 20 · 2017: 24 · 2016: 19 · 2015: 27 · 2014: 38 · 2013: 20 · 2012: 31
- FWCI
- 6.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Keywords
- fragmented QRS complex, wide QRS, myocardial scar, coronary artery disease, bundle branch block, premature ventricular contractions, paced rhythm, mortality prediction, 12-lead ECG, electrocardiographic markers
- MeSH terms
- Aged, Bundle-Branch Block, Cicatrix, Coronary Artery Disease, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Myocardium, Prognosis, Retrospective Studies, Time Factors, Reproducibility of Results, Tomography, Emission-Computed, Single-Photon, Ventricular Premature Complexes
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