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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.

journal_name

J Cardiovasc Electrophysiol

journal_title

Journal of cardiovascular electrophysiology

authors

Del-Carpio Munoz F,Noseworthy PA,Gharacholou SM,Scott CG,Nkomo VT,Lopez-Jimenez F,Cha YM,Munger TM,Friedman PA,Asirvatham SJ

doi

10.1111/jce.13656

subject

Has Abstract

pub_date

2018-09-01 00:00:00

pages

1248-1256

issue

eissn

1045-3873

issn

1540-8167

journal_volume

pub_type

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