Relationship between Fragmented QRS Complexes and Implantable Cardioverter Defibrillator Use in Patients with Structural Heart Disease

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Background: Fragmented QRS complexes (fQRS) is one of risk stratifications for arrhythmic events, although, its relationship with appropriate/inappropriate discharges of implantable cardioverter defibrillator (ICD) remains unknown. Methods: Of 98 patients treated with ICD, 20 ischemic cardiomyopathy (ICM) and 45 non-ICM (NICM) patients were enrolled. fQRS was defined as QRS with more than 2 notches in the R wave or the S wave present on more than 2 contiguous leads of inferior, lateral or anterior segments. All patients were classified into the fQRS or non-fQRS group; appropriate/inappropriate ICD discharges were retrospectively investigated. Results: Of the ICM patients, 3 had appropriate shocks and 3 had inappropriate shocks in the fQRS group (n=13), whereas 1 had appropriate shocks and 1 had inappropriate shocks in the non-fQRS group (n=7). No differences in appropriate shocks were found between the fQRS group and non-fQRS group (p=0.89). Of the NICM patients, 11 had appropriate shocks and 7 had inappropriate shocks in the fQRS group (n=31), whereas 1 had appropriate shocks and 1 had inappropriate shocks in the non-fQRS group (n=14). Appropriate shocks was more frequently used in the NICM patients in the fQRS group than those in the non-fQRS group (p=0.04, the hazard ratio 3.56). Conclusions: fQRS is a useful predictor for risk stratification in NICM patients treated with ICD.