title: fQRS as a marker of granulomatous disease in patients presenting with ventricular tachycardia and normal left ventricular ejection fraction.
abstract: BACKGROUND
  Granulomatous myocarditis may present with sustained monomorphic ventricular tachycardia (SMVT) in the presence of normal left ventricular ejection fraction (LVEF), and could be mistaken for idiopathic ventricular tachycardia (IVT). The use of cardiac imaging for diagnosis can be limited by availability and high cost. ECG is readily available and inexpensive. Fragmented QRS (fQRS) on ECG has been found to be associated with myocardial scar. We hypothesized that fQRS could be useful in the diagnosis of granulomatous VT (GVT).
  
  
  METHODS
  We compared the 12-lead ECG of 16 patients with GVT and 42 patients with IVT who presented with SMVT.
  
  
  RESULTS
  The presence of fQRS was significantly higher in the GVT group compared to the IVT group (75% versus 19.1%, p < 0.001). The location of fQRS correlated with delayed enhancement cardiac magnetic resonance imaging (DE-CMR) in the same segment in 4/16 patients in the GVT group. It correlated with an affected segment on either DE-CMR or 18FDG positron emission computed tomography in 4/11 patients in the GVT group who had both imaging modality. Whenever fQRS was present in contiguous leads other than the inferior leads, it always corresponded to an affected segment on imaging.
  
  
  CONCLUSIONS
  In patients presenting with SMVT and no structural heart disease, the presence of fQRS is strongly associated with granulomatous myocarditis. fQRS on the surface ECG is a helpful tool the presence of which should prompt a CMR for a definitive diagnosis.
authors.affiliation: University of Minnesota, Cardiovascular Division, Minneapolis, MN, USA.
authors.forename: Henri
authors.initials: H
authors.lastname: Roukoz
authors.affiliation: Department of Electrocardiology, CARE Hospital, Road No. 1, Banjara Hills, Hyderabad, India.
authors.forename: Mandar
authors.initials: M
authors.lastname: Shah
authors.affiliation: Department of Electrocardiology, CARE Hospital, Road No. 1, Banjara Hills, Hyderabad, India.
authors.forename: Lawrence Jesuraj
authors.initials: LJ
authors.lastname: Masilamani
authors.affiliation: Department of Electrocardiology, CARE Hospital, Road No. 1, Banjara Hills, Hyderabad, India.
authors.forename: Ajit
authors.initials: A
authors.lastname: Thachil
authors.affiliation: Department of Electrocardiology, CARE Hospital, Road No. 1, Banjara Hills, Hyderabad, India.
authors.forename: Prem K
authors.initials: PK
authors.lastname: Jayakumar
authors.affiliation: University of Minnesota, Cardiovascular Division, Minneapolis, MN, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Benditt
authors.affiliation: Department of Electrocardiology, CARE Hospital, Road No. 1, Banjara Hills, Hyderabad, India. Electronic address: calambur@hotmail.com.
authors.forename: Calambur
authors.initials: C
authors.lastname: Narasimhan
mesh_terms: D000328:Adult; D003952:Diagnostic Imaging / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006105:Granulomatous Disease, Chronic / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Cardiac sarcoidosis; Cardiac tuberculosis; Fragmented QRS; Granulomatous myocarditis; Ventricular tachycardia