{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:12:24Z","timestamp":1787062344742,"version":"build-2736575974"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"24","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,12,18]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Patients with tetralogy of Fallot (\n                      <jats:styled-content style=\"fixed-case\">TOF<\/jats:styled-content>\n                      ) remain at risk for cardiovascular events despite successful repair. Some of the current risk stratification tools require advanced imaging and invasive studies, and hence are difficult to apply to routine patient care. A recent study showed that\n                      <jats:styled-content style=\"fixed-case\">QRS<\/jats:styled-content>\n                      fragmentation (\n                      <jats:styled-content style=\"fixed-case\">QRS<\/jats:styled-content>\n                      \u2010f) is predictive of mortality in patients with TOF. The current study aims to validate this result by assessing whether severity of\n                      <jats:styled-content style=\"fixed-case\">QRS<\/jats:styled-content>\n                      \u2010f could predict all\u2010cause mortality in a different\n                      <jats:styled-content style=\"fixed-case\">TOF<\/jats:styled-content>\n                      population.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      The authors reviewed the Mayo Adult Congenital Heart Disease database for patients with TOF who had\n                      <jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content>\n                      from 1990\u20132017.\n                      <jats:styled-content style=\"fixed-case\">QRS<\/jats:styled-content>\n                      \u2010f was defined as notches in\n                      <jats:styled-content style=\"fixed-case\">QRS<\/jats:styled-content>\n                      complex in \u22652 contiguous leads on\n                      <jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content>\n                      , not related to bundle branch block, and classified as none, mild (\u22643 leads), moderate (4 leads), or severe (\u22655 leads). Of 465 patients (age 37\u00b114\u00a0years) in the study,\n                      <jats:styled-content style=\"fixed-case\">QRS<\/jats:styled-content>\n                      \u2010f was present in 161 (35%): mild (n=43, 9%), moderate (n=77, 17%), and severe (n=41, 9%). There were 55 deaths (12%) during 13.6\u00b18.2\u00a0years of follow\u2010up. Severity of\n                      <jats:styled-content style=\"fixed-case\">QRS<\/jats:styled-content>\n                      \u2010f remained an independent predictor of all\u2010cause mortality after adjustment for other\n                      <jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content>\n                      parameters, patient demographics, and atrial and ventricular arrhythmia (hazard ratio, 1.74 per class; 95% confidence interval, 1.08\u20132.93 [\n                      <jats:italic>P<\/jats:italic>\n                      =0.041]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      The presence of severe\n                      <jats:styled-content style=\"fixed-case\">QRS<\/jats:styled-content>\n                      \u2010f may be used as complementary data to the usual clinical indices to determine whether interventions such as invasive electrophysiology study should be performed in patients with nonsustained ventricular tachycardia or to proceed with pulmonary valve replacement in patients with severe pulmonary regurgitation with ventricular volumes below the guideline\u2010directed threshold for intervention.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.118.010274","type":"journal-article","created":{"date-parts":[[2018,12,13]],"date-time":"2018-12-13T05:00:43Z","timestamp":1544677243000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Role of QRS Fragmentation for Risk Stratification in Adults With Tetralogy of Fallot"],"prefix":"10.1161","volume":"7","author":[{"given":"Alexander C.","family":"Egbe","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester 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Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek J.","family":"Deshmukh","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Farouk Abdelsamid","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srikanth","family":"Kothapalli","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi M.","family":"Connolly","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester 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