The Relationship Between Fragmented QRS Complex and Coronary Artery Disease in Patient with Total Atrioventricular Nodal Block Requiring Permanent Pacemaker Implantation

Author : M. Rusydi, Y. Yuniadi, S. B. Raharjo, D. Hanafy, D. Yugo
Upload Date : 19-04-2018

Background: Detection of coronary artery disease (CAD) in symptomatic bradycardia patients requiring permanent pacemaker (PPM) implantation should be known early. Currently the use of advanced modalities such as cardiac catheterization and cardiac CT are the primary choice in detection of CAD in total atrioventricular block (TAVB) patients with relatively high cost and risk. The description of fragmented QRS complex (fQRS) in electrocardiography associated with the presence of ischemia or scar in the myocardium that can be an alternative detection of CAD in patients with TAVB requiring PPM implantation.

Objectives: To determine the relationship between fQRS and CAD in patients with TAVB requiring PPM implantion.

Methods: This study is an analytic study of case control using secondary data of medical record of TAVB patients who have performed PPM implantation and coronary angiography at PJN Harapan Kita hospital. The study was conducted in April-Agustus 2017. Recorded patient characteristics, factors known to influence CAD events as well as results of echocardiography and coronary angiography. The EKG readings were performed by two cardiologist consultants in the arrhythmia division.

Results: The total sample of this study was 46 consisting of 23 case and 23 control. The description of fQRS in patients with TAVB showed a trend of 2.4 times for CAD prediction compared with those without fQRS although statistically showed a non-significant (OR = 2.4; p = 0.236). Kappa test results showed good agrreement both observers with Kappa inter-observer value 0.487 and intra-observer 0.737 and 0.783.

Conclusion: Fragmented QRS complex in patients with TAVB had a tendency of 2.4 times for CAD prediction but statistically not significant.

KEYWORDS : Fragmented QRS complex, coronary artery disease, total AV nodal block, permanent pacemaker implantation

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