La fragmentación del complejo QRS del electrocardiograma y su correlación con alteraciones cardiovasculares
DOI:
https://doi.org/10.18004/mem.iics/1812-9528/2024.e22142401Palabras clave:
Complejo QRS fragmentado, electrocardiograma, cardiopatía isquémica, síndrome coronario agudoResumen
La presencia de complejos QRS fragmentados (fQRS) en un electrocardiograma (ECG) de 12 derivaciones de rutina es un marcador interesante de anormalidad de la despolarización. El fQRS representa un retraso en la conducción debido a una activación no homogénea de los ventrículos debido a una cicatriz miocárdica. Sin embargo, la fQRS no es específica de la enfermedad de las arterias coronarias y además se encuentra en otras enfermedades del miocardio como la miocardiopatía y la cardiopatía congénita. fQRS también se há descrito en otras entidades como la miocardiopatía arritmogénica del ventrículo derecho y el síndrome de Brugada. La importancia y el valor predictivo del complejo fQRS como marcador ECG de eventos cardiovasculares parecen ser diferentes en diferentes entidades. En pacientes con enfermedad arterial coronaria estable y en pacientes con infarto de miocardio agudo, la fQRS parece ser un buen predictor de eventos cardíacos. En pacientes con miocardiopatía no isquémica, la fQRS estrecho parece correlacionarse con el grado de fibrosis y disincronía, y podría influir en la respuesta a la terapia de resincronización cardíaca. En pacientes con disfunción del VI, no hay evidencia clara de que la presencia de fQRS pueda predecir eventos arrítmicos. Por otro lado, hubo diferencia estadísticamente significativa en la mortalidad asociada a la presencia de fQRS en pacientes con síndrome coronario agudo y necrosis miocárdica. La presencia de fQRS, posee una alta especificidad y un alto valor predictivo positivo debido a la existencia de trastornos segmentarios de la motilidad miocárdica en pacientes con cardiopatía isquémica.
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