Department of Cardiology, Tokyo Metropolitan Hiroo Hospital.
Circ J. 2013;77(12):2889-97. doi: 10.1253/circj.cj-13-0335. Epub 2013 Aug 13.
Fragmented QRS (fQRS) can predict cardiac events, and inducible ventricular tachycardia/fibrillation (VT/VF) is a known high-risk factor for arrhythmic death. However, whether fQRS is a predictor of cardiac events in patients with inducible VT/VF is unknown. We aimed to evaluate whether fQRS is a predictor of cardiac events in patients with structural heart disease and inducible VT/VF.
We retrospectively investigated 98 patients with structural heart disease who had a defibrillator device implanted. All patients underwent electrophysiological testing prior to or after device implantation and VT/VF was induced. fQRS was present in 30 patients. Appropriate defibrillator therapies were similar between the fQRS and non-fQRS groups (47% vs. 47%). In total, 25 patients (26%) died during a mean follow-up period of 87±43 months. All-cause mortality (12 [40%] vs. 13 [19%]) and cardiovascular deaths (9 [30%] vs. 4 [6%]) were significantly higher in the fQRS group than non-fQRS group, respectively; Kaplan-Meier analysis revealed significantly lower event-free survival for all-cause mortality (P=0.012) and cardiovascular deaths (P=0.001) for fQRS patients. A multivariable Cox regression model revealed that fQRS was an independent predictor of cardiovascular death (hazard ratio, 4.58; 95% confidence interval, 1.34-15.64; P=0.015).
fQRS is a predictor of cardiovascular death in patients with structural heart disease and inducible VT/VF.
碎裂 QRS 波（fQRS）可预测心脏事件，而诱发性室性心动过速/颤动（VT/VF）是心律失常性死亡的已知高危因素。然而，fQRS 是否是伴有可诱发性 VT/VF 的结构性心脏病患者心脏事件的预测因素尚不清楚。我们旨在评估 fQRS 是否是伴有结构性心脏病和可诱发性 VT/VF 的患者心脏事件的预测因素。
我们回顾性调查了 98 例结构性心脏病患者，这些患者均植入了除颤器装置。所有患者在装置植入前或植入后均进行了电生理检查，并诱发出 VT/VF。30 例患者存在 fQRS。在 fQRS 组和非 fQRS 组之间，适当的除颤器治疗相似（47% vs. 47%）。在平均 87±43 个月的随访期间，共有 25 例患者（26%）死亡。全因死亡率（12 [40%] vs. 13 [19%]）和心血管死亡率（9 [30%] vs. 4 [6%]）在 fQRS 组均显著高于非 fQRS 组；Kaplan-Meier 分析显示，fQRS 组的全因死亡率（P=0.012）和心血管死亡率（P=0.001）的无事件生存率显著降低。多变量 Cox 回归模型显示，fQRS 是心血管死亡的独立预测因素（危险比，4.58；95%置信区间，1.34-15.64；P=0.015）。
fQRS 是伴有结构性心脏病和可诱发性 VT/VF 的患者心血管死亡的预测因素。
