title: Fragmented QRS for the prediction of sudden cardiac death: a meta-analysis.
abstract: OBJECTIVE
  Risk stratification of sudden cardiac death (SCD) is challenging. Fragmented QRS (fQRS) is proposed as a non-invasive electrocardiogram marker associated with mortality and SCD. Results from individual studies including small numbers of patients are discrepant. We therefore performed a meta-analysis of studies evaluating fQRS as a risk stratification tool to predict all-cause mortality and SCD.
  
  
  RESULTS
  Electronic databases and bibliographies were systematically searched (1996-2014). Twelve studies (5009 patients) recruiting patients with coronary artery disease or non-ischaemic cardiomyopathy met our inclusion criteria. Fragmented QRS was associated with an all-cause mortality relative risk of 1.71 (CI 1.02-2.85) and a relative risk of SCD of 2.20 (CI 1.05-4.62). Subgroup analysis demonstrated greater mortality and SCD risk in those with left ventricular ejection fraction >35% and SCD risk in those with QRS duration <120 ms.
  
  
  CONCLUSIONS
  Fragmented QRS is associated with all-cause mortality and the occurrence of SCD and may be suited as a marker of SCD risk. The incremental benefit of fQRS should be assessed in a randomized, prospective setting.
authors.affiliation: Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth BH77DW, UK Faculty of Medicine, University of Southampton, Southampton, UK james@rosengarten.co.uk.
authors.forename: James A
authors.initials: JA
authors.lastname: Rosengarten
authors.affiliation: King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Scott
authors.affiliation: Faculty of Medicine, University of Southampton, Southampton, UK University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: John M
authors.initials: JM
authors.lastname: Morgan
mesh_terms: D009202:Cardiomyopathies / Q000401:mortality / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004562:Electrocardiography; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D018570:Risk Assessment; D013318:Stroke Volume; D016277:Ventricular Function, Left
keywords: Electrocardiography; Fragmented QRS; Meta-analysis; Risk factors; Sudden cardiac death