Association of fragmented QRS with left atrial scarring in patients with persistent atrial fibrillation undergoing radiofrequency catheter ablation

Ugur Canpolat, Sanghamitra Mohanty, Chintan Trivedi, Qiong Chen, Huseyin Ayhan, Carola Gianni, Domenico G. Della Rocca, Bryan MacDonald, J. David Burkhardt, Mohamed Bassiouny, G. Joseph Gallinghouse, Amin Al-Ahmad, Rodney Horton, Luigi Di Biase, Andrea Natale

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalHeart Rhythm
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Catheter Ablation
Atrial Fibrillation
Cicatrix
Recurrence
Tachycardia
Veins
Electrocardiography
Multivariate Analysis
Confidence Intervals

Keywords

  • Atrial scarring
  • Catheter ablation
  • Fragmented QRS
  • Nonpulmonary vein triggers
  • Persistent atrial fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Association of fragmented QRS with left atrial scarring in patients with persistent atrial fibrillation undergoing radiofrequency catheter ablation. / Canpolat, Ugur; Mohanty, Sanghamitra; Trivedi, Chintan; Chen, Qiong; Ayhan, Huseyin; Gianni, Carola; Della Rocca, Domenico G.; MacDonald, Bryan; Burkhardt, J. David; Bassiouny, Mohamed; Gallinghouse, G. Joseph; Al-Ahmad, Amin; Horton, Rodney; Di Biase, Luigi; Natale, Andrea.

In: Heart Rhythm, 01.01.2019.

Research output: Contribution to journalArticle

Canpolat, U, Mohanty, S, Trivedi, C, Chen, Q, Ayhan, H, Gianni, C, Della Rocca, DG, MacDonald, B, Burkhardt, JD, Bassiouny, M, Gallinghouse, GJ, Al-Ahmad, A, Horton, R, Di Biase, L & Natale, A 2019, 'Association of fragmented QRS with left atrial scarring in patients with persistent atrial fibrillation undergoing radiofrequency catheter ablation', Heart Rhythm. https://doi.org/10.1016/j.hrthm.2019.09.010
Canpolat, Ugur ; Mohanty, Sanghamitra ; Trivedi, Chintan ; Chen, Qiong ; Ayhan, Huseyin ; Gianni, Carola ; Della Rocca, Domenico G. ; MacDonald, Bryan ; Burkhardt, J. David ; Bassiouny, Mohamed ; Gallinghouse, G. Joseph ; Al-Ahmad, Amin ; Horton, Rodney ; Di Biase, Luigi ; Natale, Andrea. / Association of fragmented QRS with left atrial scarring in patients with persistent atrial fibrillation undergoing radiofrequency catheter ablation. In: Heart Rhythm. 2019.
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abstract = "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.",
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author = "Ugur Canpolat and Sanghamitra Mohanty and Chintan Trivedi and Qiong Chen and Huseyin Ayhan and Carola Gianni and {Della Rocca}, {Domenico G.} and Bryan MacDonald and Burkhardt, {J. David} and Mohamed Bassiouny and Gallinghouse, {G. Joseph} and Amin Al-Ahmad and Rodney Horton and {Di Biase}, Luigi and Andrea Natale",
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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

PY - 2019/1/1

Y1 - 2019/1/1

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

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