Morita Hiroshi, Watanabe Atsuyuki, Morimoto Yoshimasa, Kawada Satoshi, Tachibana Motomi, Nakagawa Koji, Nishii Nobuhiro, Ito Hiroshi
From the Department of Cardiovascular Therapeutics (H.M., N.N.) and Department of Cardiovascular Medicine (A.W., Y.M., S.K., M.T., K.N., H.I.), Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan.
Circ Arrhythm Electrophysiol. 2017 Mar;10(3). doi: 10.1161/CIRCEP.116.004765.
Fragmented QRS complexes (fQRS) in the right precordial leads are associated with occurrence of ventricular fibrillation (VF) in Brugada syndrome. Recently, epicardial mapping has revealed abnormal electrograms at the right ventricular (RV) outflow tract and inferior region of the right ventricle. fQRS may reflect the extent of the area of abnormal potentials, but whether the distribution of fQRS has prognostic value is not known.
We evaluated the existence of fQRS in 456 patients with Brugada syndrome, including 117 patients with syncope and 23 patients with VF. The region of fQRS was defined as inferior (II, III, and aVF), lateral (I, aVL, and V5 and V6), anterior (V3 and V4), RV (V1 and V2), and RV outflow tract (V1 and V2 at the third intercostal space). fQRS were present in 229 patients (RV outflow tract in 175, inferior in 135, RV in 90, and lateral in 16 patients). During follow-up (mean 91 months), 39 patients experienced VF. In univariable analyses, fQRS in any distribution and fQRS in each region excluding the RV were associated with VF. Multivariable analysis showed that fQRS in the inferior (hazard ratio, 3.9; confidence interval, 1.9-8.5), lateral (hazard ratio, 3.5; confidence interval, 1.2-8.2), and RV outflow tract (hazard ratio, 2.5; confidence interval, 1.2-5.6) were associated with VF events. The presence of multiple regions of fQRS was associated with worse prognosis.
The distribution of fQRS is associated with prognosis in Brugada syndrome, further supporting the association of fQRS and arrhythmia substrate.
右胸前导联的碎裂QRS波群（fQRS）与Brugada综合征中心室颤动（VF）的发生相关。最近，心外膜标测显示右心室（RV）流出道和右心室下区域存在异常心电图。fQRS可能反映了异常电位区域的范围，但fQRS的分布是否具有预后价值尚不清楚。
我们评估了456例Brugada综合征患者中fQRS的存在情况，其中包括117例晕厥患者和23例VF患者。fQRS区域定义为下壁（II、III和aVF）、侧壁（I、aVL以及V5和V6）、前壁（V3和V4）、RV（V1和V2）以及RV流出道（第三肋间的V1和V2）。229例患者存在fQRS（175例位于RV流出道，135例位于下壁，90例位于RV，16例位于侧壁）。在随访期间（平均91个月），39例患者发生了VF。单因素分析显示，任何分布的fQRS以及除RV外每个区域的fQRS均与VF相关。多因素分析表明，下壁fQRS（风险比，3.9；置信区间，1.9 - 8.5）、侧壁fQRS（风险比，3.5；置信区间，1.2 - 8.2）和RV流出道fQRS（风险比，2.5；置信区间，1.2 - 5.6）与VF事件相关。多个fQRS区域的存在与更差的预后相关。
fQRS的分布与Brugada综合征的预后相关，进一步支持了fQRS与心律失常基质之间的关联。
