title: QRS-fragmentation: Case report and review of the literature.
abstract: Fragmentation of QRS complex (QRSf) is an easily evaluable, non-invasive electrocardiographic parameter that represents depolarisation anomalies and has been associated with several adverse outcomes, such as sudden death, fibrosis, arrhythmic burden, and a worse prognosis in different conditions, including coronary artery disease (CAD). The case is presented of a 69-year old male referred due to symptoms of chronic stable angina. His electrocardiogram showed sinus rhythm, absence of Q waves, but the presence of QRSf in the inferior leads and V4-V6. A Tc-99 myocardial perfusion SPECT scan revealed a fixed perfusion defect in the inferolateral region, corresponding to the finding of QRSf. QRSf is an easily valuable electrocardiographic marker with relative sensitivity, but poor specificity. Its routine clinical application could contribute to an increase in the suspicion of coronary artery disease.
  
  
  CONCLUSIONS
  The presence of fragmented QRS represents distortion of signal conduction and depolarisation, which is related to myocardial scar or myocardial fibrosis.
authors.affiliation: National Institute of Cardiology Ignacio Chávez, Mexico. Electronic address: edgarillescasmd@hotmail.com.
authors.forename: Edgar
authors.initials: E
authors.lastname: Illescas-González
authors.affiliation: National Institute of Cardiology Ignacio Chávez, Mexico.
authors.forename: Diego
authors.initials: D
authors.lastname: Araiza-Garaygordobil
authors.affiliation: National Institute of Cardiology Ignacio Chávez, Mexico.
authors.forename: Jorge Daniel
authors.initials: JD
authors.lastname: Sierra Lara
authors.affiliation: Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chávez, Mexico.
authors.forename: Aristoteles
authors.initials: A
authors.lastname: Ramirez-Salazar
authors.affiliation: Coronary Care Unit, National Institute of Cardiology Ignacio Chávez, Mexico.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sierra-Fernández
authors.affiliation: Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chávez, Mexico.
authors.forename: Erick
authors.initials: E
authors.lastname: Alexanderson-Rosas
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology*; D004562:Electrocardiography; D006801:Humans; D008297:Male
keywords: Cardiomiopatía; Cardiomyopathy; Coronary artery disease; Enfermedad arterial coronaria; Fragmentación del QRS; Fragmentation of QRS; Muerte súbita; México; Prognosis; Pronóstico; Sudden death