The Presence of Fragmented QRS in Restrictive Cardiomyopathy Associated with Myocardial Fibrosis Evaluated by Cardiac Magnetic Resonance

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Introduction Fragmented QRS complex (fQRS) on 12-lead electrocardiogram (ECG) represented myocardial scar and fibrosis in coronary artery disease. However, the presence of fQRS in restrictive cardiomyopathy (RCM) has not yet been demonstrated. We investigated the relationship between fQRS and myocardial fibrosis identified as late gadolinium enhancement (LGE) areas on cardiac magnetic resonance (CMR) in patients with RCM. Methods Sixty consecutive RCM patients (50% male, age 51±19 years, mean follow-up 29±22 months) underwent CMR were included. fQRS was defined as single or multiple notches in the R or S wave in at least two contiguous ECG leads and QRS duration<120 ms. Wide QRS included any QRS morphology with QRS duration>120 ms. CMR were analyzed for the presence of LGE. Results fQRS was presented in 19 (32%) patients. LGE (+) was detected in 20 patients. Presence of LGE was significantly increased in fQRS than non fQRS group (53% vs. 4.8%, p=0.01). The frequency of ventricular tachycardia was also substantially higher in fQRS group (21% vs. 0%, p=0.03). During follow up, 27 (45%) patients died. Kaplan-Meier analysis revealed that compared with non fQRS group, fQRS group associated with a significantly lower survival (P=0.039). Conclusions the presence of fQRS on 12-lead ECG in RCM patients is closely correlated with myodocardial fibrosis detected by CMR.