title: Prevalence and prognostic significance of fragmented QRS complex in middle-aged subjects with and without clinical or electrocardiographic evidence of cardiac disease.
abstract: We wanted to evaluate the prevalence and prognostic value of the fragmented QRS (fQRS) complex, defined as changes in QRS morphology with various RSR'-patterns in 12-lead electrocardiogram (ECG) in a middle-aged general population. We evaluated the 12-lead ECGs of 10,904 Finnish middle-aged subjects (52% men, mean age 44 ± 8.5 years) with (n = 2,543) and without (n = 8,361) an evidence of cardiac disease drawn from general population and followed them for 30 ± 11 years. Fragmentation of the QRS complex was defined as various RSR'-patterns in at least 2 consecutive leads within the same territory (inferior II, III, aVF; lateral I, aVL, V4 to V6; anterior V1 to V3). Primary end points were death from any cause, cardiac, and arrhythmic deaths. In the total population, fQRS was present in 19.7% (n = 2,147) of subjects, including 15.7% (n = 1714) in inferior leads, 0.8% (n = 84) in lateral leads, and 2.9% (n = 314) in anterior leads. Fragmentation was not associated with increased mortality in subjects without a known cardiac disease. However, fQRS observed in lateral leads in subjects with an evidence of cardiac disease was associated with an increased risk of all-cause (p = 0.001), cardiac (p = 0.001), and arrhythmic (p = 0.004) mortalities. In conclusion, fQRS reflecting minor intraventricular conduction defect is a common finding, especially in the inferior leads, but it is not a sign of increased risk of mortality in subjects without a known cardiac disease. Lateral fQRS, which is less commonly observed in the ECG, is associated with a worse outcome in patients with a known cardiac disease.
authors.affiliation: Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, Oulu, Finland. Electronic address: hterho@student.oulu.fi.
authors.forename: Henri K
authors.initials: HK
authors.lastname: Terho
authors.affiliation: Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, Oulu, Finland.
authors.forename: Jani T
authors.initials: JT
authors.lastname: Tikkanen
authors.affiliation: Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, Oulu, Finland.
authors.forename: Juhani M
authors.initials: JM
authors.lastname: Junttila
authors.affiliation: Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.
authors.forename: Olli
authors.initials: O
authors.lastname: Anttonen
authors.affiliation: Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, Oulu, Finland.
authors.forename: Tuomas V
authors.initials: TV
authors.lastname: Kenttä
authors.affiliation: Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Aapo L
authors.initials: AL
authors.lastname: Aro
authors.affiliation: Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Kerola
authors.affiliation: National Institute for Health and Wellfare, Helsinki, Finland.
authors.forename: Harri A
authors.initials: HA
authors.lastname: Rissanen
authors.affiliation: National Institute for Health and Wellfare, Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Reunanen
authors.affiliation: Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, Oulu, Finland.
authors.forename: Heikki V
authors.initials: HV
authors.lastname: Huikuri
mesh_terms: D000328:Adult; D004562:Electrocardiography; D005260:Female; D005387:Finland / Q000453:epidemiology; D006329:Heart Conduction System / Q000503:physiopathology*; D006331:Heart Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis