title: Fragmented QRS complex predicts the arrhythmic events in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia.
abstract: BACKGROUND
  Fragmented QRS (frQRS) complex, with various morphology, has been recently described as a diagnostic criterion of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). However, there are little data regarding the prognostic role of frQRS in these patients. Therefore, we aimed to investigate the association of frQRS with arrhythmic events in patients with ARVC/D.
  
  
  METHODS
  Seventy-eight patients (51 men, 65.4%; mean age: 31.25 ± 11.5 years) with the diagnosis of ARVC/D according to 2010 modified Task Force Criteria were analyzed retrospectively. Baseline ECG evaluation revealed frQRS complex in 46 patients (59%). Eleven patients with complete/incomplete right bundle branch block were excluded from the study. The phenomenon of frQRS was defined as deflections at the beginning of the QRS complex, on top of the R-wave, or in the nadir of the S-wave similar to the definition in CAD in either one right precordial lead or in more than one lead including all standard ECG leads.
  
  
  RESULTS
  During 38 ± 14 months follow-up period, 3 patients (3.8%) died suddenly, 36 patients (46.1%) experienced arrhythmic events (32 ventricular tachycardias [VTs] and 4 ventricular fibrillation [VF], 30 in the ICD group). The frQRS was significantly associated with arrhythmic events (P < 0.001). Also, the number of ECG leads with frQRS complex was higher in patients with arrhythmic events (5.08 ± 2.5 vs 1.14 ± 1.7, P < 0.001, respectively).
  
  
  CONCLUSIONS
  The frQRS complex on standard 12-lead ECG predicts fatal and nonfatal arrhythmic events in patients with ARVC/D. Therefore, large scale and prospective studies are needed to confirm those findings.
authors.affiliation: Türkiye Yüksek İhtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey.
authors.forename: Uğur
authors.initials: U
authors.lastname: Canpolat
authors.forename: Giray
authors.initials: G
authors.lastname: Kabakçi
authors.forename: Kudret
authors.initials: K
authors.lastname: Aytemir
authors.forename: Muhammet
authors.initials: M
authors.lastname: Dural
authors.forename: Levent
authors.initials: L
authors.lastname: Sahiner
authors.forename: Hikmet
authors.initials: H
authors.lastname: Yorgun
authors.forename: Hamza
authors.initials: H
authors.lastname: Sunman
authors.forename: Ergün
authors.initials: E
authors.lastname: Bariş Kaya
authors.forename: Lale
authors.initials: L
authors.lastname: Tokgözoğlu
authors.forename: Ali
authors.initials: A
authors.lastname: Oto
mesh_terms: D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D016757:Death, Sudden, Cardiac; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult
keywords: QRS fragmentation; arrhythmogenic right ventricular cardiomyopathy; implantable cardioverter defibrillator; sudden cardiac death; ventricular arrhythmia