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Fragmented QRS and other depolarization abnormalities as a predictor of mortality and sudden cardiac death

Das, Mithilesh K; El Masry, Hicham

Current Opinion in Cardiology: January 2010 - Volume 25 - Issue 1 - p 59–64
doi: 10.1097/HCO.0b013e328333d35d
Arrhythmias: Edited by Anthony Tang

Purpose of review Several invasive and noninvasive tests for risk stratification of sudden cardiac death (SCD) have been studied. Tests such as microwave T wave alternans (repolarization abnormality) and signal-averaged ECG (depolarization abnormality) have high negative predictive values but low positive predictive values in patients with heart disease. The presence of a fragmented QRS (fQRS) complex on a routine 12-lead ECG is another marker of depolarization abnormality. The purpose of this review is to discuss the potential utility of tests to detect depolarization abnormalities of the heart for the risk stratification of mortality and SCD with main emphasis on fQRS.

Recent findings fQRS is associated with increased mortality and arrhythmic events in patients with coronary artery disease. fQRS has also been defined as a marker of arrhythmogenic right ventricular cardiomyopathy and Brugada syndrome. In Brugada syndrome, the presence of fQRS predicts episodes of ventricular fibrillation during follow-up.

Summary fQRS may be of value in determining the risk for SCD and guiding selection for device therapy in patients with structural heart disease and Brugada syndrome. It is possible that the predictive value of fQRS for SCD can be enhanced further by combining a marker of repolarization abnormality such as microwave T wave alternans.

Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA

Correspondence to Mithilesh Kumar Das, MD, MRCP, FACC Associate Professor of Clinical Medicine, Chief of Cardiac Electrophysiology, Roudebush VA Medical Center, Krannert Institute of Cardiology, Indiana University School of Medicine, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA Tel: +1 317 962 0101; fax: +1 317 962 0100; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.