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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.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [370]
In the citing paper
“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]
Citations
Cites
Brugada, P., & Brugada, J. (1992) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(92)90253-j · Cited by 3,344
Cardiac Electrophysiology: From Cell to Bedside
(1991) · Annals of Internal Medicine · doi:10.7326/0003-4819-114-12-1069_5 · Cited by 2,380
Yan, G., & Antzelevitch, C. (1999) · Circulation · doi:10.1161/01.cir.100.15.1660 · Cited by 1,132
Natural History of Brugada Syndrome
Priori, S. G., Napolitano, C., Gasparini, M., Pappone, C., Bella, P. E. D., Giordano, U., Bloise, R., Giustetto, C., Nardis, R. D., Grillo, M., et al. (2002) · Circulation · doi:10.1161/hc1102.105288 · Cited by 1,030
Significance of a Fragmented QRS Complex Versus a Q Wave in Patients With Coronary Artery Disease
Das, M. K., Khan, B. R., Jacob, S., Kumar, A., & Mahenthiran, J. (2006) · Circulation · doi:10.1161/circulationaha.105.595892 · Cited by 632
Brugada Syndrome: Report of the Second Consensus Conference
(2005) · Heart Rhythm · doi:10.1016/j.hrthm.2005.01.005 · Cited by 609
Right Ventricular Fibrosis and Conduction Delay in a Patient With Clinical Signs of Brugada Syndrome
Coronel, R., Casini, S., Koopmann, T. T., Schopman, F. J. G., Verkerk, A. O., de Groot, J. R., Bhuiyan, Z. A., Bezzina, C. R., Veldkamp, M. W., Linnenbank, A. C., et al. (2005) · Circulation · doi:10.1161/circulationaha.105.532614 · Cited by 441
Ionic and Cellular Basis for the Predominance of the Brugada Syndrome Phenotype in Males
Diego, J. M. D., Cordeiro, J. M., Goodrow, R. J., Fish, J. M., Zygmunt, A. C., Pérez, G. J., Scornik, F. S., & Antzelevitch, C. N. (2002) · Circulation · doi:10.1161/01.cir.0000032002.22105.7a · Cited by 393
Meregalli, P. G., Wilde, A. A. M., & Tan, H. L. (2005) · Cardiovascular Research · doi:10.1016/j.cardiores.2005.03.005 · Cited by 373
Das, M. K., Saha, C., Masry, H. E., Peng, J. A., Dandamudi, G., Mahenthiran, J., McHenry, P. L., & Zipes, D. P. (2007) · Heart Rhythm · doi:10.1016/j.hrthm.2007.06.024 · Cited by 330
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KUSANO, K. F. (2014) · Internal Medicine · doi:10.2169/internalmedicine.53.2713
Self-citationQRS Fragmentation as a Prognostic Test in Acute Coronary Syndrome
Abdel-Rahman, T. M. (2013) · World Journal of Cardiovascular Surgery · doi:10.4236/wjcs.2013.32008
Ozawa, K., Funabashi, N., Takaoka, H., Ueda, M., & Kobayashi, Y. (2014) · International Journal of Cardiology · doi:10.1016/j.ijcard.2014.06.067
Fragmented QRS and Left Ventricular Geometry in Hypertensive Patients
Bekar, L., & Celebi, S. A. (2013) · Koşuyolu Heart Journal · doi:10.5578/kkd.4653
Electrocardiographic Characteristics of Ventricular Arrhythmia in Inherited Channelopathies
Methachittiphan, N., Deeprasertkul, P., & Link, M. (2014) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2014.05.013
Kurita, T. (2013) · Journal of Arrhythmia · doi:10.1016/j.joa.2013.03.001
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Nunn, L. M., Bhar-Amato, J., Lambiase, P. D., Lambiase, P. D., & Nunn, L. M. (2010)
Review Article A Review of the Mechanisms of Ventricular Arrhythmia in
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J Wave and Fragmented QRS Formation as a Biomarker
Shimizu, M., & Nishizaki, M. (2016) · Springer eBooks · doi:10.1007/978-94-007-7678-4_26
Amoretti, R. (2013)
QRS Fragmentation Outcome in Patients Receiving Cardiac Resynchronization Therapy
Mollazadeh, R., Noori, S., Tabatabaei, P., Emkanjoo, Z., & Eslami, M. (2016) · International Journal of Medical Education · doi:10.17795/jcce-5282
Ning, X., Tang, M., Chen, K., Hua, W., Chen, R.-H., Sha, J., Liu, Z., & Zhang, S. (2012)
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央, 齊., 真吾, 加., 亜由美, 田., 貴子, 石., こず恵, 中., 紀隆, 斉., 満美子, 中., & 一喜, 福. (2016) · doi:10.11272/jss.41.239
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Antzelevitch, C., & Patocskai, B. (2016) · Springer eBooks · doi:10.1007/978-3-319-31578-2_3 · Cited by 2
Update on the Differential Diagnosis and Treatment of Brugada Syndrome
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Scheinman, M. M., & Hoffmayer, K. S. (2017) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2017.04.007
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Aiba, T. (2017) · Springer eBooks · doi:10.1007/978-981-10-3379-7_4
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Lovegrove, H. (2017) · British Journal of Cardiac Nursing · doi:10.12968/bjca.2017.12.10.504
Takagi, M., Sekiguchi, Y., Yokoyama, Y., Aihara, N., Hiraoka, M., Aonuma, K., & Japan Idiopathic Ventricular Fibrillation Study (J-IVFS) Investigators (2018) · EP Europace · doi:10.1093/europace/euy108
Brugada Syndrome: Current Perspectives
Khongphatthanayothin, A., & Nademanee, K. (2018) · Cardiac and vascular biology · doi:10.1007/978-3-319-77812-9_8
Tomcsányi, J. (2018) · Orvosi Hetilap · doi:10.1556/650.2018.31234
Yamagata, K., Aiba, T., & Shimizu, W. (2018) · Japanese Journal of Electrocardiology · doi:10.5105/jse.38.269
The prognostic role of fragmented QRS complex in acute myocarditis
Ünal, S., YİLMAZ, S., Yayla, Ç., Kuyumcu, M. S., Erbay, İ., Açar, B., Karanfil, M., Ertem, A. G., Demırtas, K., Akdi, A., et al. (2019) · Turkish Journal of Clinics and Laboratory · doi:10.18663/tjcl.516494
de Sá, E. L., & Rosillo, S. O. (2019) · Revista Clínica Española · doi:10.1016/j.rce.2019.01.007
López-de-Sa, E., & Rosillo, S. O. (2019) · Revista Clínica Española (English Edition) · doi:10.1016/j.rceng.2019.01.012
Influence of fragmented QRS complex in patients with paroxysmal atrial fibrillation
Oa, C., Jm, T., Lb, G., & Scavenius, K. E. (2018) · Blood Heart and Circulation · doi:10.15761/bhc.1000142
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Giudicessi, J., & Ackerman, M. (2019) · Cardiac Repolarization · doi:10.1007/978-3-030-22672-5_17
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Walsh, K., & Deo, R. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-812532-8.00004-5
Clinical approach to the patient with Brugada Syndrome: risk stratification and optimal management
Marinković, M. M., Mujović, N. M., & Potpara, T. (2020) · Panminerva Medica · doi:10.23736/s0031-0808.19.03736-4
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Sorajja, D. (2020) · Springer eBooks · doi:10.1007/978-3-030-44507-2_16
Shatla, I. M., Sammour, Y. M., Iskandarani, M. E., & López‐Candales, A. (2021) · Cureus · doi:10.7759/cureus.13748
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Bayés‐Genís, A., Fiol, M., Bayés‐Genís, A., Baranchuk, A. M., Elosúa, R., & Martínez‐Sellés, M. (2021) · doi:10.1002/9781119536475.ch13
Bayés‐Genís, A., Fiol, M., Bayés‐Genís, A., Baranchuk, A. M., Elosúa, R., & Martínez‐Sellés, M. (2021) · Wiley eBooks · doi:10.1002/9781119536475.ch21
de Luna, A. B., & FCCS, A. B. M. F. F. (2017) · Wiley eBooks · doi:10.1002/9781119212782.ch9
de Luna, A. B. (2011) · Wiley eBooks · doi:10.1002/9781444391749.ch9
Ishii, Y., Nakagawa, M., Abe, I., Kondo, H., Fukui, A., Akioka, H., Shinohara, T., Teshima, Y., Yufu, K., & Takahashi, N. (2020) · doi:10.22541/au.159969804.48517684
Banu, A., & Manjunath, K. (2022) · Lecture notes in networks and systems · doi:10.1007/978-981-16-7657-4_54
Mahfouz, R. A., Elawady, W. S., Sherif, A. S., & Abdelwanis, M. S. M. (2022) · The Egyptian Journal of Hospital Medicine · doi:10.21608/ejhm.2022.227718
Schulze‐Bahr, E. (2015) · Springer eBooks · doi:10.1007/978-3-642-54676-1_199-1
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Scrocco, C., & Behr, E. R. (2020) · Springer eBooks · doi:10.1007/978-3-030-52173-8_2
Bastiaenen, R., & Behr, E. R. (2011) · Cardiogenetics · doi:10.4081/cardiogenetics.2011.s1.e3
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Viriyanukulvong, K., Theerasuwipakorn, N., Wongcharoen, W., Kosum, P., & Chokesuwattanaskul, R. (2024) · Research Square · doi:10.21203/rs.3.rs-4625808/v1
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Chahal, C. A. A., & Landstrom, A. P. (2025) · Springer eBooks · doi:10.1007/978-3-319-66816-1_1221-1
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Metadata
- 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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