Fragmented QRS Is Associated with All-Cause Mortality and Ventricular Arrhythmias in Patient with Idiopathic Dilated Cardiomyopathy

Background: Several studies have showed that fragmented QRS complexes (f-QRS, defined as different RSR' patterns) on a routine 12-lead electrocardiogram were associated with increased mortality and arrhythmic events in patients with coronary artery disease, but relatively little data were available regarding idiopathic dilated cardiomyopathy (IDCM). Objective: The purpose of this study was to evaluate the relationship between fragmentation of QRS and the combined end point of all-cause mortality and ventricular arrhythmias in patients with IDCM. Methods: One hundred twenty-eight patients with IDCM and left ventricular dysfunction (ejection fraction, EF <= 40%) were analyzed, respectively. According to QRS duration and the existence of f-QRS on 12-lead electrocardiograph (ECG), the study populations were divided into three groups: (1) the f-QRS group (QRS <= 120 ms and with fragmented QRS, n = 51), (2) the wide QRS (wQRS) group (QRS >= 120 ms, n = 48), and (3) the nonfragmented QRS (non-fQRS) group (QRS < 120 ms and without f-QRS, n = 29). Results: During a mean follow-up of 14 +/- 5 months, 25 (19.5%) patients had deaths and ventricular arrhythmic events. The combined end point of all-cause mortality and ventricular tachyarrhythmias was significantly higher in the f-QRS and wQRS groups than the non-fQRS group (23.5%, 25%, and 3.4%, respectively; P < 0.05 for both). Event-free was significantly decreased in the f-QRS group versus the non-fQRS group (P = 0.02). Univaritae regression analysis revealed that f-QRS was a stronger predictor of mortality and arrhythmic events in IDCM patients. Conclusion: f-QRS on 12-lead ECG has a high predictive value for the combined end point of all-cause mortality and ventricular tachyarrhythmias in IDCM patients with left ventricular dysfunction. Ann Noninvasive Electrocardiol 2011; 16(3): 270-275