QRS COMPLEX FRAGMENTATION — AN IMPORTANT MARKER OF ABNORMAL DEPOLARIZATION

Aim. To investigate on the QRS complex fragmentation (fQRS) in patients with idiopathic ventricular arrhythmias (VA) .

Material and methods. Totally, 125 patients, selected into 2 groups: 1st group — 100 patients (mean age 46,4±14,1 y., 69 females) with idiopathic VRD. Patients had predominating daytime arrhythmia (63%), more oftenly — monomorphic ventricular exstrasystolic complexes (VE) (59%), in 39% patients — paroxysms of nonsustained ventricular tachicardia. Structural pathology of myocardium was ruled out based on electrocardiography data, echocardiography, in some cases — magnetic resonance. Second, control group — 25 pts. (69,0±11 y. o., 12 females) with VRD of ischemic origin (coronary heart disease, myocardial infarction in anamnesis). In this group, polymorphic (84%) daytime (68%) VE predominated, and in 25% — nonsustained ventricular tachicardia. Analysis was done with Holter ECG in 12 leads (“KTResult 2”, “Inkart” JSC).

Results. In the 1st group, fQRS of sinus complexes was registered in 2 patients (2%) and was transient. Relations in 24-hour dynamics of fQRS were not found. FQRS in VE was registered in 25 patients (25%). One patient had fQRS of sinus complexes as well as fQRS in VE. In 17 patients (68%) fQRS was found in VE. In controls, fQRS of sinus complexes was found in 6 patients (24%), fQRS of VE — in 23 (92%) and was permanent.

Conclusion. The phenomenon of fQRS can be found during routine instrumental investigation (standard ECG or Holter ECG), and is more common for CHD patients, being significant criteria for repolarization processes evaluation. Looking for fQRS in patients with idiopathic VRD, probably, is related to dysbalance of autonomous nervous regulation that leads to electrical instability of myocardium. It cannot be ruled out that fQRS might be an early marker of cardiomyopathies. It is necessary to investigate on this phenomenon further and to find its place in risk stratification of sudden cardiac death of patients with no structural heart pathology.

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