Fragmented QRS as a Predictor of In-Hospital Major Adverse Cardiovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation.

Fragmented QRS (fQRS) on electrocardiography (ECG) is a known marker of myocardial fibrosis and electrical instability. However, its prognostic role in patients undergoing transcatheter aortic valve implantation (TAVI) remains uncertain. This study aimed to evaluate whether the presence of fQRS on preprocedural ECG is associated with increased risk of in-hospital major adverse cardiovascular events (MACE) in patients undergoing TAVI for severe aortic stenosis. A total of 149 patients undergoing TAVI between 2018 and 2025 were retrospectively analyzed. Patients were divided into 2 groups based on the presence of fQRS. Clinical, laboratory, and echocardiographic parameters were compared, and multivariate logistic regression was used to identify independent predictors of in-hospital MACE. fQRS was present in 54 patients (36.2%) and was significantly associated with higher incidence of in-hospital MACE (48.1% vs 18.9%, p < 0.001). Patients with fQRS also had lower glomerular filtration rates (p = 0.009) and higher rates of contrast-induced acute kidney injury (p = 0.002). Multivariate analysis confirmed that fQRS (odds ratio [OR] 3.773, p = 0.002), low hemoglobin levels (OR: 0.721, p = 0.003), and smaller valve size (OR: 0.858, p = 0.024) were independent predictors of MACE. In conclusion, the presence of fQRS on preprocedural ECG is independently associated with a higher risk of in-hospital MACE in patients undergoing TAVI. fQRS may serve as a simple, non-invasive marker to improve perioperative risk stratification and clinical decision-making in this high-risk population.