TY - JOUR
T1 - Association of fragmented QRS with left atrial scarring in patients with persistent atrial fibrillation undergoing radiofrequency catheter ablation
AU - Canpolat, Ugur
AU - Mohanty, Sanghamitra
AU - Trivedi, Chintan
AU - Chen, Qiong
AU - Ayhan, Huseyin
AU - Gianni, Carola
AU - Della Rocca, Domenico G.
AU - MacDonald, Bryan
AU - Burkhardt, J. David
AU - Bassiouny, Mohamed
AU - Gallinghouse, G. Joseph
AU - Al-Ahmad, Amin
AU - Horton, Rodney
AU - Di Biase, Luigi
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2019 Heart Rhythm Society
PY - 2020/2
Y1 - 2020/2
N2 - Background: Fragmented QRS (fQRS) on 12-lead electrocardiography is a noninvasive marker of intramyocardial conduction delay due to ventricular scarring that has not previously been studied in atrial fibrillation. Objective: The purpose of this study was to assess the association of fQRS with left atrial (LA) scarring in patients with persistent atrial fibrillation (PsAF) undergoing first catheter ablation. Methods: A total of 376 patients with PsAF were enrolled. Severity of LA scarring was assessed using electroanatomic mapping. Narrow fQRS was defined by the presence of an additional R wave (R′) or notching in the nadir of the S wave, or the presence of >1 R′ in 2 contiguous leads corresponding to inferior, lateral, or anterior myocardial regions. Results: Both any degree (97.3% vs 63.3%) and severe (42.2% vs 6.3%) LA scarring were higher in patients with fQRS. Age and fQRS were found to be independent predictors of severe LA scarring. At multiple ventricular regions, fQRS had diagnostic accuracy of 79.8% for prediction of severe LA scarring. Nonpulmonary vein triggers were more often detected and ablated in patients with fQRS and severe LA scarring (84.4% vs 70%; P = .001). Atrial tachyarrhythmia recurrence was observed in 131 patients (34.8%) during 18.9 ± 7.7 months of follow-up, which was significantly higher in patients with fQRS (53.2% vs 16.8%). In multivariate analysis, fQRS was found to be a significant predictor of recurrence (hazard ratio 4.65; 95% interval confidence 2.91–7.42; P <.001). Conclusion: The study results showed that fQRS is a simple, available, and noninvasive marker, and that fQRS at multiple ventricular regions is significantly associated with the severity of LA scarring in PsAF patients.
AB - Background: Fragmented QRS (fQRS) on 12-lead electrocardiography is a noninvasive marker of intramyocardial conduction delay due to ventricular scarring that has not previously been studied in atrial fibrillation. Objective: The purpose of this study was to assess the association of fQRS with left atrial (LA) scarring in patients with persistent atrial fibrillation (PsAF) undergoing first catheter ablation. Methods: A total of 376 patients with PsAF were enrolled. Severity of LA scarring was assessed using electroanatomic mapping. Narrow fQRS was defined by the presence of an additional R wave (R′) or notching in the nadir of the S wave, or the presence of >1 R′ in 2 contiguous leads corresponding to inferior, lateral, or anterior myocardial regions. Results: Both any degree (97.3% vs 63.3%) and severe (42.2% vs 6.3%) LA scarring were higher in patients with fQRS. Age and fQRS were found to be independent predictors of severe LA scarring. At multiple ventricular regions, fQRS had diagnostic accuracy of 79.8% for prediction of severe LA scarring. Nonpulmonary vein triggers were more often detected and ablated in patients with fQRS and severe LA scarring (84.4% vs 70%; P = .001). Atrial tachyarrhythmia recurrence was observed in 131 patients (34.8%) during 18.9 ± 7.7 months of follow-up, which was significantly higher in patients with fQRS (53.2% vs 16.8%). In multivariate analysis, fQRS was found to be a significant predictor of recurrence (hazard ratio 4.65; 95% interval confidence 2.91–7.42; P <.001). Conclusion: The study results showed that fQRS is a simple, available, and noninvasive marker, and that fQRS at multiple ventricular regions is significantly associated with the severity of LA scarring in PsAF patients.
KW - Atrial scarring
KW - Catheter ablation
KW - Fragmented QRS
KW - Nonpulmonary vein triggers
KW - Persistent atrial fibrillation
UR - http://www.scopus.com/inward/record.url?scp=85073972641&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85073972641&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2019.09.010
DO - 10.1016/j.hrthm.2019.09.010
M3 - Article
C2 - 31518722
AN - SCOPUS:85073972641
SN - 1547-5271
VL - 17
SP - 203
EP - 210
JO - Heart Rhythm
JF - Heart Rhythm
IS - 2
ER -