Fragmented QRS and atrial tachyarrhythmia occurrence after catheter ablation for atrial fibrillation or atrial flutter: a meta-analysis.

BACKGROUND

Fragmented QRS (fQRS) on electrocardiography reflects myocardial conduction abnormalities and has been proposed as a potential marker of atrial structural remodeling. However, its prognostic value for atrial tachyarrhythmia occurrence after catheter ablation for atrial fibrillation (AF) or atrial flutter (AFL) remains uncertain. We conducted a meta-analysis to clarify the association between fQRS and post-ablation atrial tachyarrhythmia occurrence.

METHODS

PubMed, Embase, Web of Science, Wanfang, and CNKI were systematically searched for longitudinal observational studies evaluating the association between baseline or early peri-procedural fQRS and atrial tachyarrhythmia occurrence after catheter ablation for AF or AFL. The primary outcome was post-ablation atrial tachyarrhythmia, including AF, AFL, or atrial tachycardia. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models accounting for the influence of potential heterogeneity.

RESULTS

Six cohort studies involving 1064 patients were included. During follow-up ranging from 3 to 43.2 months, 331 patients developed atrial tachyarrhythmia after ablation. The presence of fQRS was significantly associated with a higher risk of post-ablation atrial tachyarrhythmia occurrence (pooled RR = 2.11, 95% CI 1.55-2.87; I2 = 66%). This association remained consistent in subgroup analyses stratified by arrhythmia type (AF vs AFL), timing of fQRS assessment, and follow-up duration.

CONCLUSIONS

Fragmented QRS is associated with a more than twofold increased risk of atrial tachyarrhythmia occurrence after catheter ablation for AF or AFL. As a simple and widely available electrocardiographic marker, fQRS may aid in pre-procedural risk stratification and individualized post-ablation management.