Diagnostic value of fragmented QRS complex in myocardial scar detection: systematic review and meta-analysis of the literature

Background and aim: The present study aimed to investigate the diagnostic value of fragmented QRS complex (fQRS) on 12-lead electrocardiogram (ECG) for myocardial scar detection, and presented the results in a systematic review and meta-analysis format. Methods: Medline, SCOPUS, and ISI Web of Knowledge were searched electronically with "Fragmented QRS" or "fQRS" as key words. All related studies that had evaluated the accuracy of fQRS for myocardial scar diagnosis were included. Results: Eight studies (2560 patients) were finally included in the systematic review. Specificity assessment could be evaluated only by five out of these eight articles. Overall pooled sensitivity of fQRS, Q wave, and mixed Q-fQRS was 68% (65-71), 51% (47-55), and 74% (69-79) and the pooled specificity was 80% (79-81), 97% (97-98) and 92% (91-93), respectively. Conclusions: Fragmented QRS is a novel ECG marker with more sensitivity and less specificity than Q wave. A combination of fQRS with Q wave in a 12-lead ECG results in up to 74% sensitivity and 92% specificity. Additional studies are needed to assess the significance of this ECG parameter for regional myocardial scar detection.