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Fragmentierter QRS-Komplex

Bedeutung in der klinischen Praxis

Fragmented QRS

Relevance in clinical practice

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Der QRS-Komplex bildet die Erregungsausbreitung des ventrikulären Myokards elektrokardiographisch ab. Ist sie ungestört, findet sich ein unauffällig konfigurierter QRS-Komplex von normaler Dauer. Ist sie aufgrund pathologischer Veränderungen gestört, kommt es zu einer Verbreiterung des QRS-Komplexes. Bei Unterbrechung eines Tawara-Schenkels findet sich das Bild eines klassischen Schenkelblocks. Ist eine Zuordnung zu einem klassischen Schenkelblock aufgrund einer atypischen QRS-Konfiguration nicht möglich und finden sich Einkerbungen der R- oder der S-Zacken, spricht man von fragmentierten QRS-Komplexen. Das pathophysiologische Korrelat der fragmentierten QRS-Komplexe ist vielfältig: Es kann sich um Myokardnarben im Rahmen einer koronaren Herzerkrankung, um fibrotische Myokardareale anderer Genese, um primäre Herzerkrankungen oder systemische Erkrankungen mit kardialer Beteiligung handeln. Auch Funktionsstörungen auf zellulärer Ebene, z. B. von Ionenkanälen, können mit fragmentierten QRS-Komplexen einhergehen. Neben der diagnostischen Bedeutung werden fragmentierte QRS-Komplexe zunehmend auch prognostische Eigenschaften zugesprochen, z. B. bei der Identifikation von Hochrisikopatienten bei koronarer Herzerkrankung, Kardiomyopathien, Brugada-Syndrom und Long-QT-Syndrom. Allerdings können fragmentierte QRS-Komplexe auch beim Gesunden beobachtet werden.

Abstract

The QRS complex represents the electrical depolarization of ventricular myocardium. In the case of an undisturbed depolarization, the QRS complex has a normal configuration and duration, but abnormal electrical conduction leads to widening of the QRS complex. The block of one of the Tawara branches results in a typical bundle branch block pattern. A QRS complex that cannot be classified as bundle branch block due to an atypical configuration and contains notched R or S waves is called a fragmented QRS. The underlying pathophysiologies are manifold and include myocardial scars induced by ischemic heart disease, myocardial fibrosis due to other diseases, primary cardiac pathologies as well as systemic diseases with cardiac involvement. Pathologies on the cellular level, such as ion channel dysfunctions, also correlate with fragmented QRS. Besides the diagnostic relevance, fragmented QRS is known to have prognostic properties, for example in identifying high risk patients with coronary artery disease, cardiomyopathy, Brugada syndrome and acquired long QT syndrome; however, fragmented QRS may also be detected in ECGs of healthy individuals.

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Notes

  1. Dem Perfusionsgebiet einer Koronararterie entsprechend.

Abbreviations

ARVD:

Arrhythmogene rechtsventrikuläre Dysplasie

CRT:

Kardiale Resynchronisationstherapie

EKG:

Elektrokardiogramm

MACE:

Major adverse cardiac event, kardiales Ereignis

SCD:

Plötzlicher Herztod („sudden cardiac death“)

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Authors and Affiliations

  1. I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland

    Alexander Steger, Daniel Sinnecker, Anna Berkefeld, Alexander Müller, Josef Gebhardt, Michael Dommasch, Katharina M. Huster, Petra Barthel & Georg Schmidt

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Correspondence to Alexander Steger.

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A. Steger, D. Sinnecker, M. Dommasch, A. Müller, J. Gebhardt, A. Berkefeld, K. M. Huster, P. Barthel und G. Schmidt geben an, dass kein Interessenkonflikt besteht.

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Steger, A., Sinnecker, D., Berkefeld, A. et al. Fragmentierter QRS-Komplex. Herzschr Elektrophys 26, 235–241 (2015). https://doi.org/10.1007/s00399-015-0390-6

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