Abstract 14408: Inferior QRS Fragmentation Pattern on Surface Electrocardiogram- A Marker of Right Ventricular Out Flow Tract Aneurysm in Operated Tetralogy of Fallot
Introduction: Fragmented QRS complexes (fQRS) on 12-lead ECG have been shown to correlate with myocardial scar. Some have also postulated a link with LV aneurysm. No studies have reported the prevalence or clinical significance of fQRS in the surgically operated tetralogy of Fallot (TOF) cohort.
Hypothesis: The presence of right ventricular outflow tract aneurysm (RVOTa) in TOF patients has been shown to predict worsening RV dysfunction. Therefore, we assessed the hypothesis that the presence of fQRS on ECG would predict RVOTa in operated TOF patients.
Methods: The ECG (RBBB n=47, 81%) of 57 TOF patients (Age 29 ± 13 years, male=33, 58%) with moderate to severe pulmonary regurgitation (PR), referred for cardiac magnetic resonance imaging (CMRI) between 2008 to present, were analyzed within 65 days (IQR 26-148) of CMRI. fQRS were defined by the presence of ≥1 notches in the R or S wave or ≥2 notches in typical bundle branch block, in >2 contiguous leads representing anterior, lateral or inferior myocardial segments.
Results: fQRS was observed in 34 (60%) of patients and almost half (n=27, 47%) demonstrated CMRI defined evidence of RVOTa. The sensitivity and specificity of detecting RVOTa by fQRS on ECG were 93% and 70% respectively with a negative predictive value of 91%, p<0.001. Comparison of baseline variables between patients with RVOTa versus those without is summarized in the table. Results of multivariate analysis showed that fQRS specifically involving all 3 inferior leads, was an independent predictor for the presence of RVOTa (OR 8.45, 95% CI 1.2-59.2, p=0.032), after correcting for confounding variables.
Conclusions: There is an increased incidence of fQRS in operated TOF patients. In addition, the presence of inferior fQRS may represent a novel ECG marker for localizing RVOTa and potentially may be useful in identifying patients at risk of developing malignant ventricular arrhythmias.
- © 2011 by American Heart Association, Inc.