101. Fragmented QRS Is a Novel Risk Factor for Ventricular Arrhythmic Events After Receiving Cardiac Resynchronization Therapy in Nonischemic Cardiomyopathy
- Author
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Yuichi Noguchi, Hiroshi Tada, Kenji Kuroki, Akihiko Nogami, Takeshi Machino, Hiro Yamasaki, Miyako Igarashi, Tomoko Ishizu, Yoshihiro Seo, Nobuyuki Murakoshi, Yukio Sekiguchi, and Kazutaka Aonuma
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,medicine ,cardiovascular diseases ,030212 general & internal medicine ,Brugada syndrome ,medicine.diagnostic_test ,business.industry ,Hazard ratio ,medicine.disease ,Implantable cardioverter-defibrillator ,Heart failure ,cardiovascular system ,Cardiology ,Electrical conduction system of the heart ,Cardiology and Cardiovascular Medicine ,business ,Electrocardiography ,circulatory and respiratory physiology - Abstract
Fragmented QRS and Ventricular Arrhythmias After CRTIntroduction A fragmented QRS (fQRS) is reported to be associated with a poor prognosis or sudden cardiac death (SCD) in patients with Brugada syndrome or ischemic heart disease. However, no studies have clarified the impact of the presence of an fQRS on SCD or ventricular arrhythmic events in patients receiving cardiac resynchronization therapy (CRT). This study aimed to clarify this point in patients with nonischemic cardiomyopathy. Methods and Results This study included 137 heart failure patients with nonischemic cardiomyopathy who received CRT (NYHA functional class: II/III/IV = 25/84/28). The 12-lead ECGs before and after CRT were analyzed. The presence of an fQRS was decided in accordance with the definition in previous papers. Before the CRT, an fQRS was observed in 67 patients (fQRS-pre; 49%). However, it was masked in 35 (52% of fQRS-pre) patients after the CRT. Inversely, in 70 patients in whom an fQRS was absent before the CRT, it appeared after the CRT in 15 (21%) patients. As a result, 47 patients (34%) had an fQRS after the CRT (fQRS-post), and it was less than that before the CRT (P = 0.014). During 18 months of follow-up, SCD or ventricular arrhythmic events were observed more frequently in patients with an fQRS-post than in those without (36.2% vs. 3.3%, P < 0.001). A Cox regression analysis revealed that an fQRS-post was significantly associated with those events (hazard ratio = 9.18; 95% confidence interval = 2.45–34.48, P = 0.001). Conclusion In patients with nonischemic cardiomyopathy who received CRT, an fQRS-post was independently associated with SCD or ventricular arrhythmic events.
- Published
- 2017