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Effect of heart rate and pacing mode on QRS fragmentation: implications for identification of patients with impaired ejection fraction and ventricular tachycardia

Session Poster session 3

Speaker Stefanos Despotopoulos

Congress : EHRA 2018

  • Sub-topic : Arrhythmias, General: Non-invasive Diagnostic Methods
  • Session type : Poster Session
  • FP Number : P1124

Authors : S Despotopoulos (Patras,GR), F Zagkli (Patras,GR), J Chiladakis (Patras,GR)


S Despotopoulos1 , F Zagkli1 , J Chiladakis1 , 1University Hospital of Patras, Department of Cardiology - Patras - Greece ,

European Heart Journal Supplements ( 2018 ) 20 ( Supplement 1 ), i210

Introduction: We investigated the effect of heart rate and pacing mode on the QRS fragmentation (f-QRS) and correlated the findings with the ability of f-QRS to distinguish patients with impaired left ventricular ejection function (EF) and ventricular tachycardia (VT) from patients with normal EF.

Method: The study included 306 dual-chamber device recipients who were in sinus rhythm and had preserved atrioventricular conduction. Patients were grouped according to their normal or impaired EF (35 ± 9%) as well as to their baseline narrow or wide QRS. Intrinsic f-QRS in the presence of narrow or wide QRS (f-nQRS, f-wQRS) as well as ventricular-paced f-QRS (f-pQRS) were analyzed following different heart rates (baseline, 100 bpm) and pacing modes.

Results: Patients with impaired-EF VT, compared to those with normal EF, had more f-nQRS or f-wQRS (56% versus 27%, P < 0.001) and f-pQRS (62% versus 16%, P < 0.0001), irrespective of their baseline QRS. The increased heart rate led to similar detections of intrinsic f-QRS. Ventricular pacing conferred both at baseline, compared with the nonpaced QRS, and at higher rate significantly more f-pQRS in patients with impaired-EF VT (P < 0.001). Detection of f-pQRS improved overall specificity (84%) and positive predictive value (91%) in identifying patients with impaired-EF VT, whereby, along with f-wQRS, it appeared particularly useful in patients with baseline wide QRS. (Table I.)

Conclusion: Increased heart rate or/and pacing reveal more fragmented QRS. The presence of f-pQRS as well as f-wQRS offer promise towards noninvasive identification of patients with impaired-EF VT.

QRS-fragmentation Sensitivity (%) Specificity (%) PPV (%) NPV (%)
f-QRS-BL 56.2 73 83.6 40.6
f-QRS-100bpm 59.2 64.6 77.5 43.4
f-pQRS-BL 62.2 84.3 90.6 47.8
f-pQRS-100bpm 78.8 67.4 85.5 56.6
Diagnostic performance of QRS fragmentation to distinguish patients with impaired-EFVT from patients with normal EF. BL=baseline heart rate, f-QRS= fragmented intrinsic QRS, f-pQRS= fragmented paced QRS, PPV= positive predictive value, NPV= negative predictive value

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