Fragmentation of QRS complex during ventricular pacing is associated with ventricular arrhythmic events in patients with left ventricular dysfunction

Research output: Contribution to journalArticle

Abstract

Background: QRS fragmentation (fQRS) during baseline ventricular conduction, a myocardial fibrosis marker, is associated with increased risk of ventricular tachyarrhythmias but may not manifest unless ventricular activation change is provoked. We examined the association of fQRS during right ventricular (RV) pacing with death and ventricular tachyarrhythmia in patients with left ventricular (LV) dysfunction undergoing electrophysiology study (EPS). Methods and results: Study participants had LV dysfunction (ejection fraction < 50%) undergoing EPS from January 2002 to May 2014 at Mayo Clinic in Rochester, Minnesota. fQRS during RV stimulation involved >2 notches on R/S waves identified in ≥2 contiguous standard electrocardiographic leads representing anterior, inferior, or lateral ventricular segments. Primary outcomes were ventricular tachyarrhythmias that were symptomatic or required intervention and total and cardiac deaths. In all, 528 patients participated (mean age, 65 years; male sex, 80%). Of them, 312 (59%) had ischemic cardiomyopathy and mean (SD) left ventricular ejection fraction (LVEF) of 33.2% (9.5%); 457 (87%) had implantable cardiac devices (implanted defibrillator, n = 380). Mean (SD) follow-up was 3.2 (3.0) years. fQRS during RV pacing was observed in 292 patients (60%) in any ventricular segment. Patients with fQRS during RV pacing had 2.5 higher rate of ventricular tachyarrhythmia events than patients with no fQRS (hazard ratio [95% CI], 2.45 [1.5–4.2]; P < 0.01), after correcting for baseline ventricular conduction defect and QRS duration, LVEF, inducible sustained ventricular tachycardia, diabetes mellitus, chronic kidney disease, and ischemic cardiomyopathy. Conclusions: RV stimulation can unmask fQRS, and it is associated with increased risk of ventricular tachyarrhythmia in LV dysfunction.

Original languageEnglish (US)
Pages (from-to)1248-1256
Number of pages9
JournalJournal of Cardiovascular Electrophysiology
Volume29
Issue number9
DOIs
StatePublished - Sep 1 2018
Externally publishedYes

Fingerprint

Left Ventricular Dysfunction
Tachycardia
Cardiomyopathies
Stroke Volume
Defibrillators
Electrophysiology
Ventricular Tachycardia
Chronic Renal Insufficiency
Diabetes Mellitus
Fibrosis
Equipment and Supplies

Keywords

  • cardiomyopathy
  • fragmentation QRS
  • heart failure
  • sudden death
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{cf1685d9594447a68df428495a312923,
title = "Fragmentation of QRS complex during ventricular pacing is associated with ventricular arrhythmic events in patients with left ventricular dysfunction",
abstract = "Background: QRS fragmentation (fQRS) during baseline ventricular conduction, a myocardial fibrosis marker, is associated with increased risk of ventricular tachyarrhythmias but may not manifest unless ventricular activation change is provoked. We examined the association of fQRS during right ventricular (RV) pacing with death and ventricular tachyarrhythmia in patients with left ventricular (LV) dysfunction undergoing electrophysiology study (EPS). Methods and results: Study participants had LV dysfunction (ejection fraction < 50{\%}) undergoing EPS from January 2002 to May 2014 at Mayo Clinic in Rochester, Minnesota. fQRS during RV stimulation involved >2 notches on R/S waves identified in ≥2 contiguous standard electrocardiographic leads representing anterior, inferior, or lateral ventricular segments. Primary outcomes were ventricular tachyarrhythmias that were symptomatic or required intervention and total and cardiac deaths. In all, 528 patients participated (mean age, 65 years; male sex, 80{\%}). Of them, 312 (59{\%}) had ischemic cardiomyopathy and mean (SD) left ventricular ejection fraction (LVEF) of 33.2{\%} (9.5{\%}); 457 (87{\%}) had implantable cardiac devices (implanted defibrillator, n = 380). Mean (SD) follow-up was 3.2 (3.0) years. fQRS during RV pacing was observed in 292 patients (60{\%}) in any ventricular segment. Patients with fQRS during RV pacing had 2.5 higher rate of ventricular tachyarrhythmia events than patients with no fQRS (hazard ratio [95{\%} CI], 2.45 [1.5–4.2]; P < 0.01), after correcting for baseline ventricular conduction defect and QRS duration, LVEF, inducible sustained ventricular tachycardia, diabetes mellitus, chronic kidney disease, and ischemic cardiomyopathy. Conclusions: RV stimulation can unmask fQRS, and it is associated with increased risk of ventricular tachyarrhythmia in LV dysfunction.",
keywords = "cardiomyopathy, fragmentation QRS, heart failure, sudden death, ventricular tachycardia",
author = "{Del-Carpio Munoz}, Freddy and Peter Noseworthy and Shahyar Gharacholou and Scott, {Christopher G.} and Nkomo, {Vuyisile T} and Francisco Lopez-Jimenez and Yong-Mei Cha and Munger, {Thomas M.} and Friedman, {Paul Andrew} and Asirvatham, {Samuel J}",
year = "2018",
month = "9",
day = "1",
doi = "10.1111/jce.13656",
language = "English (US)",
volume = "29",
pages = "1248--1256",
journal = "Journal of Cardiovascular Electrophysiology",
issn = "1045-3873",
publisher = "Wiley-Blackwell",
number = "9",

}

TY - JOUR

T1 - Fragmentation of QRS complex during ventricular pacing is associated with ventricular arrhythmic events in patients with left ventricular dysfunction

AU - Del-Carpio Munoz, Freddy

AU - Noseworthy, Peter

AU - Gharacholou, Shahyar

AU - Scott, Christopher G.

AU - Nkomo, Vuyisile T

AU - Lopez-Jimenez, Francisco

AU - Cha, Yong-Mei

AU - Munger, Thomas M.

AU - Friedman, Paul Andrew

AU - Asirvatham, Samuel J

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: QRS fragmentation (fQRS) during baseline ventricular conduction, a myocardial fibrosis marker, is associated with increased risk of ventricular tachyarrhythmias but may not manifest unless ventricular activation change is provoked. We examined the association of fQRS during right ventricular (RV) pacing with death and ventricular tachyarrhythmia in patients with left ventricular (LV) dysfunction undergoing electrophysiology study (EPS). Methods and results: Study participants had LV dysfunction (ejection fraction < 50%) undergoing EPS from January 2002 to May 2014 at Mayo Clinic in Rochester, Minnesota. fQRS during RV stimulation involved >2 notches on R/S waves identified in ≥2 contiguous standard electrocardiographic leads representing anterior, inferior, or lateral ventricular segments. Primary outcomes were ventricular tachyarrhythmias that were symptomatic or required intervention and total and cardiac deaths. In all, 528 patients participated (mean age, 65 years; male sex, 80%). Of them, 312 (59%) had ischemic cardiomyopathy and mean (SD) left ventricular ejection fraction (LVEF) of 33.2% (9.5%); 457 (87%) had implantable cardiac devices (implanted defibrillator, n = 380). Mean (SD) follow-up was 3.2 (3.0) years. fQRS during RV pacing was observed in 292 patients (60%) in any ventricular segment. Patients with fQRS during RV pacing had 2.5 higher rate of ventricular tachyarrhythmia events than patients with no fQRS (hazard ratio [95% CI], 2.45 [1.5–4.2]; P < 0.01), after correcting for baseline ventricular conduction defect and QRS duration, LVEF, inducible sustained ventricular tachycardia, diabetes mellitus, chronic kidney disease, and ischemic cardiomyopathy. Conclusions: RV stimulation can unmask fQRS, and it is associated with increased risk of ventricular tachyarrhythmia in LV dysfunction.

AB - Background: QRS fragmentation (fQRS) during baseline ventricular conduction, a myocardial fibrosis marker, is associated with increased risk of ventricular tachyarrhythmias but may not manifest unless ventricular activation change is provoked. We examined the association of fQRS during right ventricular (RV) pacing with death and ventricular tachyarrhythmia in patients with left ventricular (LV) dysfunction undergoing electrophysiology study (EPS). Methods and results: Study participants had LV dysfunction (ejection fraction < 50%) undergoing EPS from January 2002 to May 2014 at Mayo Clinic in Rochester, Minnesota. fQRS during RV stimulation involved >2 notches on R/S waves identified in ≥2 contiguous standard electrocardiographic leads representing anterior, inferior, or lateral ventricular segments. Primary outcomes were ventricular tachyarrhythmias that were symptomatic or required intervention and total and cardiac deaths. In all, 528 patients participated (mean age, 65 years; male sex, 80%). Of them, 312 (59%) had ischemic cardiomyopathy and mean (SD) left ventricular ejection fraction (LVEF) of 33.2% (9.5%); 457 (87%) had implantable cardiac devices (implanted defibrillator, n = 380). Mean (SD) follow-up was 3.2 (3.0) years. fQRS during RV pacing was observed in 292 patients (60%) in any ventricular segment. Patients with fQRS during RV pacing had 2.5 higher rate of ventricular tachyarrhythmia events than patients with no fQRS (hazard ratio [95% CI], 2.45 [1.5–4.2]; P < 0.01), after correcting for baseline ventricular conduction defect and QRS duration, LVEF, inducible sustained ventricular tachycardia, diabetes mellitus, chronic kidney disease, and ischemic cardiomyopathy. Conclusions: RV stimulation can unmask fQRS, and it is associated with increased risk of ventricular tachyarrhythmia in LV dysfunction.

KW - cardiomyopathy

KW - fragmentation QRS

KW - heart failure

KW - sudden death

KW - ventricular tachycardia

UR - http://www.scopus.com/inward/record.url?scp=85054155497&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054155497&partnerID=8YFLogxK

U2 - 10.1111/jce.13656

DO - 10.1111/jce.13656

M3 - Article

C2 - 29858880

AN - SCOPUS:85054155497

VL - 29

SP - 1248

EP - 1256

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

IS - 9

ER -