ArticleFrontiers in physiology2016
QRS Fragmentation Patterns Representing Myocardial Scar Need to Be Separated from Benign Normal Variants: Hypotheses and Proposal for Morphology based Classification.
Article in Frontiers in physiology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
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Who cites it
24 citing papers in PubMed, 60 citations in OpenAlex.
- Exploring the association of electrocardiographic markers and arrhythmic risk in hypertrophic cardiomyopathy: A systematic review and meta-analysis.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Review
- Intrinsicoid Deflection of the QRS Complex Predicts Appropriate Antitachycardia Pacing or Shock Therapy in Heart Failure Patients with an Implantable Cardioverter Defibrillator.Brazilian journal of cardiovascular surgery · 2026Article
- Risk Factors for QRS-Fragmentation in Patients with STEMI Undergoing PCI.Medicina (Kaunas, Lithuania) · 2025Article
- Predictive Value of Electrocardiographic Markers Versus Echocardiographic and Clinical Measures for Appropriate ICD Shocks in Heart Failure Patients.Journal of clinical medicine · 2025Article
- Diagnostic performance of the fragmented QRS complex on electrocardiogram for detecting myocardial scars assessed by 3.0 Tesla cardiac magnetic resonance imaging.Heart rhythm O2 · 2025Article
- Ventricular Depolarization Abnormalities and Their Role in Cardiac Risk Stratification - A Narrative Review.Reviews in cardiovascular medicine · 2025Review
- Ventriculo-arterial (VA) coupling and fQRS as new selection criteria for primary prevention ICD placement.Intensive care medicine experimental · 2024Article
- Physiological Changes in QRS Fragmentation in Athletes and Nonathletes without Cardiac Disease.Journal of clinical medicine · 2024Article
- Fragmented QRS as a Predictor of Cardiovascular Events in Patients with Type 2 Diabetes Mellitus: A 36-Month Follow-Up Data.Anatolian journal of cardiology · 2024Article
- AI-enabled detection of QRS fragmentation from 12-lead electrocardiogram and its clinical relevance for predicting malignant arrhythmia onset.Frontiers in cardiovascular medicine · 2024Article
- QRS fragmentation does not predict mortality in survivors of acute myocardial infarction.Clinical cardiology · 2024Article
- Longitudinal ECG changes in tetralogy of Fallot and association with surgical repair.Frontiers in cardiovascular medicine · 2024Article
- Electrocardiographic variables associated with underlying Brugada syndrome or drug-induced Type 1 Brugada pattern in patients with slow/fast atrioventricular nodal reentrant tachycardia.Journal of arrhythmia · 2022Article
- Left Ventricular Non-Compaction Cardiomyopathy-Still More Questions than Answers.Journal of clinical medicine · 2022Review
- Deciphering hypertrophic cardiomyopathy with electrocardiography.Heart failure reviews · 2022Review
- Dilated left ventricle with multiple outpouchings - a severe congenital ventricular diverticulum or left-dominant arrhythmogenic cardiomyopathy: A case report.World journal of clinical cases · 2022Article
- Q waves are the strongest electrocardiographic variable associated with primary prophylactic implantable cardioverter-defibrillator benefit: a prospective multicentre study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2022Article
- A machine learning algorithm for electrocardiographic fQRS quantification validated on multi-center data.Scientific reports · 2022Article
- Early Diagnosis of Acute Myocarditis in the ED: Proposal of a New ECG-Based Protocol.Diagnostics (Basel, Switzerland) · 2022Article
- Clinical utility of 12-lead electrocardiogram in evaluating heart disease in patients with muscular dystrophy: Assessment of left ventricular hypertrophy, conduction disease, and cardiomyopathy.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2021Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The presence of a fragmented QRS complex (fQRS) in two contiguous leads of a standard 12-lead electrocardiogram (ECG) has been shown to be an indicator of myocardial scar in multiple different populations of cardiac patients. QRS fragmentation is also a predictor of adverse prognosis in acute myocardial infarction, coronary artery disease, and ischemic cardiomyopathy and a prognostic tool in structural heart diseases. An increased risk of sudden cardiac death associated with fQRS has been documented in patients with ischemic cardiomyopathy and hypertrophic cardiomyopathy. However, fQRS is also frequently observed in apparently healthy subjects. Thus, a more detailed classification of different QRS fragmentations is needed to identify the pathological fragmentation patterns and refine the role of fQRS as a risk marker of adverse cardiac events and sudden cardiac death. In most studies fQRS has been defined by the presence of an additional R wave (R'), or notching in the nadir of the S wave, or the presence of >1 R' in two contiguous leads corresponding to a major coronary territory. However, this approach does not discriminate between minor and major fragmentations and the location of the fQRS is also neglected. In addition to this, the method is susceptible to large interobserver variability. We suppose that some fQRS subtypes result from conduction delays in the His-Purkinje system, which is a benign finding and thus can weaken the prognostic values of fQRS. The classification of fQRSs to subtypes with unambiguous definitions is needed to overcome the interobserver variability related issues and to separate fQRSs caused by myocardial scarring from benign normal variants. In this paper, we review the anatomic correlates of fQRS and the current knowledge of prognostic significance of fQRS. We also propose a detailed fQRS classification for research purposes which can later be simplified after the truly pathological morphologies have been identified. The research material of our study consist of 15,245 ECGs from the random general population and approximately six thousands (
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