title: Predictive value of fragmented QRS in primary prevention implantable cardioverter defibrillator recipients with left ventricular dysfunction.
abstract: BACKGROUND
  In primary prevention implantable cardioverter defibrillator (ICD) patients, the incidence of appropriate ICD therapy is relatively low, prompting better risk stratification. Fragmented QRS (fQRS) on a 12-lead ECG has been associated with adverse outcomes. The aim of this study was to evaluate the prognostic value of fQRS in ICD recipients.
  
  
  METHODS
  Consecutive ICD patients implanted at our institution for primary prevention of sudden cardiac death (SCD) were retrospectively evaluated. Patients were divided in two groups based on the presence or the absence of fQRS on the ECG obtained before ICD implantation. The endpoint of the study was all-cause mortality or the occurrence of any appropriate ICD-delivered therapy, whether shock or antitachycardia pacing.
  
  
  RESULTS
  Among 394 ICD recipients (334 men, age 66.4  ±  11.0), fQRS was observed in 103 patients (26.1%). There were 189 patients (48.0%) with wide QRS at the time of implantation. Among these patients, fQRS was found in 29 individuals (28.2%). Patients in fQRS(+) group were more likely to have coronary artery disease and a lower QRS duration than those without fQRS. During a mean follow-up of 26.3  ±  17.5 months, mortality or ICD therapy were 19.4 and 22.4%, respectively, for fQRS(+) patients, and 15.2 and 22.8% for fQRS(-) patients (P = NS). By Kaplan-Meier analysis, event-free survival was similar in the two groups.
  
  
  CONCLUSIONS
  In ICD recipients for primary prevention of SCD, fQRS is not helpful in selecting a subgroup of patients who benefit from prophylactic ICD implantation.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Forleo
authors.forename: Domenico G
authors.initials: DG
authors.lastname: Della Rocca
authors.forename: Lida P
authors.initials: LP
authors.lastname: Papavasileiou
authors.forename: Germana
authors.initials: G
authors.lastname: Panattoni
authors.forename: Domenico
authors.initials: D
authors.lastname: Sergi
authors.forename: Lucia
authors.initials: L
authors.lastname: Duro
authors.forename: Karim
authors.initials: K
authors.lastname: Mahfouz
authors.forename: Giulia
authors.initials: G
authors.lastname: Magliano
authors.forename: Luca
authors.initials: L
authors.lastname: Santini
authors.forename: Francesco
authors.initials: F
authors.lastname: Romeo
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000009:adverse effects; D018572:Disease-Free Survival; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000295:instrumentation*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left