{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T02:11:02Z","timestamp":1792030262046,"version":"4.4.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2008,10]]},"abstract":"<jats:p>\n            <jats:bold>\n              <jats:italic>Background\u2014<\/jats:italic>\n            <\/jats:bold>\n            Fragmented QRS (duration &lt;120 ms) on a 12-lead ECG represents myocardial scar in patients with coronary artery disease. However, the significance of fragmented QRS has not been defined in the presence of a wide QRS (wQRS; duration \u2265120 ms). We postulate that fragmented wQRS (f-wQRS) due to bundle branch block, premature ventricular complexes, or paced rhythms (f-pQRS) signify myocardial scar and higher mortality.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Methods and Results\u2014<\/jats:italic>\n            <\/jats:bold>\n            Patients who underwent cardiac evaluation with nuclear stress imaging or cardiac catheterization and had wQRS (bundle branch block, premature ventricular complex, or pQRS) were studied. f-wQRS was defined by the presence of &gt;2 notches on the R wave or the S wave and had to be present in \u22652 contiguous inferior (II, III, aVF), lateral (I, aVL, V\n            <jats:sub>6<\/jats:sub>\n            ) or anterior (V\n            <jats:sub>1<\/jats:sub>\n            to V\n            <jats:sub>5<\/jats:sub>\n            ) leads. ECG analyses of 879 patients (age, 66.7\ufffd11.4 years; male, 97%; mean follow-up, 29\ufffd18 months) with bundle branch block (n=310), premature ventricular complex (n=301), and pQRS (n=268) revealed f-wQRS in 415 (47.2%) patients. Myocardial scar was present in 440 (50%) patients. The sensitivity, specificity, positive predictive value, and negative predictive value of f-wQRS for myocardial scar were 86.8%, 92.5%, 92.0%, and 87.5%, respectively. The sensitivity and specificity for diagnosing myocardial scar were 88.6% and 94.4%, 81.4% and 88.4%, and 89.8% and 95.7% for f-bundle branch block, f-premature ventricular complex, and f-pQRS, respectively. f-wQRS was associated with mortality after adjusting for age, ejection fraction, and diabetes (\n            <jats:italic>P<\/jats:italic>\n            =0.017).\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Conclusions\u2014<\/jats:italic>\n            <\/jats:bold>\n            f-wQRS on a standard 12-lead ECG is a moderately sensitive and highly specific sign for myocardial scar in patients with known or suspected coronary artery disease. f-wQRS is also an independent predictor of mortality.\n          <\/jats:p>","DOI":"10.1161\/circep.107.763284","type":"journal-article","created":{"date-parts":[[2008,7,15]],"date-time":"2008-07-15T00:34:45Z","timestamp":1216082085000},"page":"258-268","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":311,"title":["Fragmented Wide QRS on a 12-Lead ECG"],"prefix":"10.1161","volume":"1","author":[{"given":"Mithilesh K.","family":"Das","sequence":"first","affiliation":[{"name":"From the Krannert Institute of Cardiology (M.K.D., H.S., W.M., M.A.M., J.P., G.D., J.M.), Indiana University School of Medicine; and Division of Biostatistics (C.S.), Department of Medicine, Indiana University School of Medicine, Indianapolis."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussam","family":"Suradi","sequence":"additional","affiliation":[{"name":"From the Krannert Institute of Cardiology (M.K.D., H.S., W.M., M.A.M., J.P., G.D., J.M.), Indiana University School of Medicine; and Division of Biostatistics (C.S.), Department of Medicine, Indiana University School of Medicine, Indianapolis."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waddah","family":"Maskoun","sequence":"additional","affiliation":[{"name":"From the Krannert Institute of Cardiology (M.K.D., H.S., W.M., M.A.M., J.P., G.D., J.M.), Indiana University School of Medicine; and Division of Biostatistics (C.S.), Department of Medicine, Indiana University School of Medicine, Indianapolis."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Michael","sequence":"additional","affiliation":[{"name":"From the Krannert Institute of Cardiology (M.K.D., H.S., W.M., M.A.M., J.P., G.D., J.M.), Indiana University School of Medicine; and Division of Biostatistics (C.S.), Department of Medicine, Indiana University School of Medicine, Indianapolis."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changyu","family":"Shen","sequence":"additional","affiliation":[{"name":"From the Krannert Institute of Cardiology (M.K.D., H.S., W.M., M.A.M., J.P., G.D., J.M.), Indiana University School of Medicine; and Division of Biostatistics (C.S.), Department of Medicine, Indiana University School of Medicine, Indianapolis."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Peng","sequence":"additional","affiliation":[{"name":"From the Krannert Institute of Cardiology (M.K.D., H.S., W.M., M.A.M., J.P., G.D., J.M.), Indiana University School of Medicine; and Division of Biostatistics (C.S.), Department of Medicine, Indiana University School of Medicine, Indianapolis."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gopi","family":"Dandamudi","sequence":"additional","affiliation":[{"name":"From the Krannert Institute of Cardiology (M.K.D., H.S., W.M., M.A.M., J.P., G.D., J.M.), Indiana University School of Medicine; and Division of Biostatistics (C.S.), Department of Medicine, Indiana University School of Medicine, Indianapolis."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo","family":"Mahenthiran","sequence":"additional","affiliation":[{"name":"From the Krannert Institute of Cardiology (M.K.D., H.S., W.M., M.A.M., J.P., G.D., J.M.), Indiana University School of Medicine; and Division of Biostatistics (C.S.), Department of Medicine, Indiana University School of Medicine, Indianapolis."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.105.595892"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-0736(05)80258-4"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960130309"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02584541"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(92)90648-F"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.37.1.20"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.81.4.1690614"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s002590100618"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.105.4.539"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2005.10.005"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/80.3.557"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2007.06.024"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5273(99)00102-3"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/res.36.1.1116215"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.91.5.1480"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(84)90270-9"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/0022-0736(88)90061-1"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.40.6.927"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960241009"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(96)00669-8"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01203-7"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(88)90245-1"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.65.3.6459890"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi580"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(83)90007-3"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(86)90199-2"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jelectrocard.2007.03.010"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9592.2002.01061.x"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2007.03.063"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2005.08.028"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi683"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(87)80162-6"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-474X.2007.00150.x"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2006.06.020"},{"key":"e_1_3_2_35_2","first-page":"S211","volume":"4","year":"2007","unstructured":"Maskoun W, Suradi H, Mahenthiran J, Bhakta D, Das M. 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