Fragmented QRS complexes in veteran athletes

Abstract Background QRS fragmentation (fQRS), characterized by multiple peaks within the QRS, is considered an adverse risk marker that may indicate underlying myocardial fibrosis and has been implicated in cardiomyopathies. The presence of fQRS is often noted in pre-participation screening of athletes. In this study, we aimed to investigate the prevalence and clinical significance of fQRS in a cohort of ostensibly fit veteran athletes (VA). Methods We recruited 314 predominantly Caucasian VA's with a history of endurance exercise and no traditional risk factors for coronary artery disease. Participants underwent a 12-lead electrocardiogram, cardiopulmonary exercise testing (CPET), 24-hour Holter monitoring, and cardiac magnetic resonance imaging (CMR). fQRS was categorized as >2 consecutive leads using established criteria (1). Results fQRS in 2 or more contiguous leads was identified in 12% of VA's. The presence of fQRS was more prevalent in males and increased with age (p < 0.05). There were no significant differences in ECG conduction indices. When CMR parameters were considered, the presence of fQRS was associated with increased left ventricular (LV) mass index and increased right ventricular (RV) function. There was no relationship with the presence of late gadolinium enhancement. Athletes with fQRS achieved a significantly lower predicted peak VO2 and trended towards lower peak resistance on CPET. No relationship was observed with total ventricular premature beat count or the presence of complex ectopy on 24-hour Holter monitoring. Conclusions fQRS in 2 or more contiguous leads is commonly present amongst male Caucasian VA’s, and its prevalance increases with age. It is associated with greater LV mass and increased RV ejection fraction. Athletes with fQRS may achieve a lower percentage predicted VO2 max compared to those without. Furthermore, FQRS did not predict late gadolinium enhancement, increased VPB count or complex ectopy.Comparing VAs with FQRSQRS-fragmentation patterns (Das et al)