Published Online
on May 22, 2006

A more recent version of this article appeared on May 30, 2006

This Article Full Text (PDF) All Versions of this Article: 113/21/2495    most recent CIRCULATIONAHA.105.595892v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Das, M. K. Articles by Mahenthiran, J. Search for Related Content PubMed PubMed Citation Articles by Das, M. K. Articles by Mahenthiran, J. Related Collections Electrocardiology Nuclear cardiology and PET Chronic ischemic heart disease

Submitted on October 19, 2005
Revised on March 16, 2006
Accepted on March 23, 2006

Significance of a Fragmented QRS Complex Versus a Q Wave in Patients With Coronary Artery Disease

Mithilesh K. Das MD, MRCP^*, Bilal Khan MD, Sony Jacob MD, Awaneesh Kumar BS, and Jo Mahenthiran MRCP

From the Krannert Institute of Cardiology (M.K.D., B.K., S.J., J.M.), Indiana School of Medicine, Indianapolis, Ind, and the College of Arts and Sciences (A.K.), New York University, New York, NY.

^* To whom correspondence should be addressed. E-mail: midas{at}iupui.edu.

Background--Q waves on a 12-lead ECG are markers of a prior myocardial infarction (MI). However, they may regress or even disappear over time, and there is no specific ECG sign of a non-Q-wave MI. Fragmented QRS complexes (fQRSs), which include various RSR' patterns, without a typical bundle-branch block are markers of altered ventricular depolarization owing to a prior myocardial scar. We postulated that the presence of an fQRS might improve the ability to detect a prior MI compared with Q waves alone by ECG.

Methods and Results--A cohort of 479 consecutive patients (mean±SD age, 58.2±13.2 years; 283 males) who were referred for nuclear stress tests was studied. The fQRS included various morphologies of the QRS (<120 ms), which included an additional R wave (R') or notching in the nadir of the S wave, or >1 R' (fragmentation) in 2 contiguous leads, corresponding to a major coronary artery territory. The Q wave was present in 71 (14.8%) patients, an fQRS was present in 191 (34.9%) patients, and an fQRS and/or a Q wave was present in 203 (42.3%) patients. Sensitivity, specificity, and the negative predictive value for myocardial scar as detected by single photon emission computed tomography analysis were 36.3%, 99.2%, and 70.8%, respectively, for the Q wave alone; 85.6%, 89%, and 92.7%, respectively, for the fQRS; and 91.4%, 89%, and 94.2%, respectively, for the Q wave and/or fQRS.

Conclusions--The fQRS on a 12-lead ECG is a marker of a prior MI, defined by regional perfusion abnormalities, which has a substantially higher sensitivity and negative predictive value compared with the Q wave.

Key words: electrocardiography • myocardial infarction • scintigraphy

This article has been cited by other articles:

				H. Morita, K. F. Kusano, D. Miura, S. Nagase, K. Nakamura, S. T. Morita, T. Ohe, D. P. Zipes, and J. Wu Fragmented QRS as a Marker of Conduction Abnormality and a Predictor of Prognosis of Brugada Syndrome Circulation, October 21, 2008; 118(17): 1697 - 1704. [Abstract] [Full Text] [PDF]

				R. E. Eckart, M. E. Field, T. W. Hruczkowski, D. E. Forman, S. Dorbala, M. F. Di Carli, C. E. Albert, W. H. Maisel, L. M. Epstein, and W. G. Stevenson Association of Electrocardiographic Morphology of Exercise-Induced Ventricular Arrhythmia with Mortality Ann Intern Med, October 7, 2008; 149(7): 451 - 460. [Abstract] [Full Text] [PDF]

				M. K. Das, H. Suradi, W. Maskoun, M. A. Michael, C. Shen, J. Peng, G. Dandamudi, and J. Mahenthiran Fragmented Wide QRS on a 12-Lead ECG: A Sign of Myocardial Scar and Poor Prognosis Circ Arrhythm Electrophysiol, October 1, 2008; 1(4): 258 - 268. [Abstract] [Full Text] [PDF]