title: Prognostic value of QRS fragmentation in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia.
abstract: BACKGROUND
  QRS fragmentation, including epsilon potentials, terminal activation delay and prolonged S wave upstroke, has been recently described as a diagnostic criterion of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). Whether QRS fragmentation is a marker of recurrent ventricular tachycardia, primary ventricular fibrillation, implantable cardioverter defibrillator (ICD) discharge and sudden cardiac death in these patients is unknown.
  
  
  RESULTS
  Three hundred and thirty-five patients (167 men, mean age 46.3 ± 14.6 years) with ARVC/D according to International Society and Federation of Cardiology/European Society of Cardiology (ISFC/ESC) criteria were analyzed retrospectively. Patients with complete and incomplete right bundle branch block were excluded from the analysis. At 6.3 ± 3.1 years mean follow-up, seven patients (0.02%) had died suddenly, 39 patients (0.13%) experienced recurrent ventricular tachycardia, 32 patients (0.1%) presented with primary ventricular fibrillation and 30 patients (0.1%) had recurrent ICD discharges. QRS fragmentation was significantly associated with arrhythmic events (P < 0.0000001 for the endpoint of sudden cardiac death, P < 0.01 for recurrent ventricular tachycardia, P < 0.0001 for primary ventricular fibrillation and P < 0.001 for recurrent ICD discharges, respectively).
  
  
  CONCLUSIONS
  QRS fragmentation predicts arrhythmic events in patients with ARVC/D. Further, properly designed prospective studies are warranted to confirm these findings.
authors.affiliation: Department of Cardiology and Intensive Care, Asklepios Harzkliniken Goslar, Goslar, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Peters
authors.forename: Martina
authors.initials: M
authors.lastname: Truemmel
authors.forename: Brigitte
authors.initials: B
authors.lastname: Koehler
mesh_terms: D000200:Action Potentials; D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016009:Chi-Square Distribution; D016757:Death, Sudden, Cardiac / Q000209:etiology; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation; D004562:Electrocardiography; D005260:Female; D005858:Germany; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology / Q000503:physiopathology