Fragmented QRS as a Marker of Conduction Abnormality and a Predictor of Prognosis of Brugada Syndrome
Abstract
BACKGROUND: Conduction abnormalities serve as a substrate for ventricular fibrillation (VF) in patients with Brugada syndrome (BS). Signal-averaged electrograms can detect late potentials, but the significance of conduction abnormalities within the QRS complex is still unknown. The latter can present as multiple spikes within the QRS complex (fragmented QRS [f-QRS]). We hypothesized that f-QRS could indicate a substrate for VF and might predict a high risk of VF for patients with BS. METHODS AND RESULTS: In study 1, we analyzed the incidence of f-QRS in 115 patients with BS (13 resuscitated from VF, 28 with syncope, and 74 asymptomatic). f-QRS was observed in 43% of patients, more often in the VF group (incidence of f-QRS: VF 85%, syncope 50%, and asymptomatic 34%, P<0.01). SCN5A mutations occurred more often in patients with f-QRS (33%) than in patients without f-QRS (5%). In patients with syncope or VF, only 6% without f-QRS experienced VF during follow-up (43+/-25 months), but 58% of patients with f-QRS had recurrent syncope due to VF (P<0.01). In study 2, to investigate the mechanism of f-QRS, we studied in vitro models of BS in canine right ventricular tissues (n=4) and optically mapped multisite action potentials. In the experimental model of BS, ST elevation resulted from a large phase 1 notch of the action potential in the epicardium, and local epicardial activation delay reproduced f-QRS in the transmural ECG. CONCLUSIONS: f-QRS appears to be a marker for the substrate for spontaneous VF in BS and predicts patients at high risk of syncope.
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A drug-induced type 1 ECG pattern has a lower risk of sudden death than a spontaneous type 1 response in Brugada syndrome.
“A drug-induced type 1 ECG pattern has a lower risk of sudden death than a spontaneous type 1 response.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [370]
Fragmented QRS is a substrate for spontaneous fibrillation in patients with Brugada syndrome and predicts a high risk of syncope.
“Fragmented QRS was found to be a substrate for spontaneous fibrillation in patients with BS and predicted a high risk of syncope in these patients.30”
From The Year of 2008 in Electrocardiology (2010) · cites this paper as [30]
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- Authors
- Morita, H., Kusano, K. F., Miura, D., Nagase, S., Nakamura, K., Morita, S. T., Ohe, T., Zipes, D. P., & Wu, J.
- Affiliations
- Okayama University (JP)
- ORCID
- Venue
- Circulation
- Published
- 2008-10-21
- Volume
- 118
- Issue
- 17
- Pages
- 1697-1704
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2134949933
- Cited by
- 470
- References
- 26
- Citations by year
- 2026: 7 · 2025: 18 · 2024: 13 · 2023: 14 · 2022: 19 · 2021: 19 · 2020: 18 · 2019: 41 · 2018: 40 · 2017: 39 · 2016: 41 · 2015: 33 · 2014: 34 · 2013: 36 · 2012: 35
- FWCI
- 15.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- Brugada syndrome, fragmented QRS complex, conduction abnormalities, ventricular fibrillation, syncope, SCN5A mutation, ventricular arrhythmia substrate
- MeSH terms
- Adult, Aged, Animals, Dogs, Electrocardiography, Female, Heart Conduction System, Humans, Male, Middle Aged, Predictive Value of Tests, Prognosis, Ventricular Fibrillation, Brugada Syndrome
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