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ragmented QRS (fQRS) wave, defined as additional spikes within the QRS wave, additional R waves, notched S wave, or >1R’ wave, is an easily evaluated, noninvasive electrocardiographic feature and has been shown to be a marker of subsequent myocardial scar, resulting in an intraventricular conduction defect, and has been postulated to be predictive of outcomes in various cardiac diseases, such as ischemic heart disease,1 arrhythmogenic right ventricular cardiomyopathy,2 sarcoidosis,3 Brugada syndrome4 and acquired long QT syndrome.5 Historically, slurring and changes in the QRS wave have been investigated since the 1960 s when Flowers et al demonstrated that these QRS wave (they called them high-frequency components) were more commonly observed in patients with prior myocardial infarction and either right and left ventricular enlargement.6 After that, many studies compared the utility of the fQRS wave and Q wave for detecting myocardial scar in patients with coronary artery disease,7–9 and their usefulness for predicting cardiac events, sudden cardiac death, risk of requiring implantable cardioverter defibrillator (ICD)10 and response to cardiac resynchronization therapy (CRT)11 in ischemic or non-ischemic heart disease and other cardiac diseases. It is now believed that the fQRS wave can be caused by zigzag conduction around the scarred myocardium,10 resulting in multiple spikes within the QRS complex, and myocardial scar detected by the fQRS wave is strongly associated with subsequent ventricular dysfunction and is a substrate for reentrant ventricular arrhythmias (VT/ VF), but the true mechanism is still unclear.12

Fragmented QRS Wave as a Marker of Cardiac Events in Various Cardiac Diseases