7-041 Longitudinal follow-up of QRS fragmentation in athletes

Yamagata, Kentaro ORCID: https://orcid.org/0000-0003-4124-6421, Cowie, Charlotte, Sharma, Sanjay and Malhotra, Aneil (2025) 7-041 Longitudinal follow-up of QRS fragmentation in athletes. In: Heart, A237-A238. Presented at British Cardiovascular Society Annual Conference, 2 June - 4 June 2025, Manchester Central Convention Complex, Manchester, UK.

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Abstract

Background QRS fragmentation (fQRS) is defined as the presence of single or multiple notches in the nadir of the S wave, an additional R wave (R’), or the presence of >1 spiked or slurred R’ wave. fQRS is associated with myocardial fibrosis and arrhythmic events in patients with cardiomyopathy. However, it is also reported in up to 35% of healthy athletes. The long-term implications of fQRS are unknown. We aimed to assess the longitudinal change of fQRS in male and female professional athletes. Methods Between October 2017 and 2024, 5,316 consecutive elite football players (52% males), underwent pre-participation screening with ECG and echocardiogram. 1,710 (32%) also had >1 screen with a mean period between screens of 3.4±1.8 years. fQRS morphology was classified into five patterns: Rn, RnS, RSn, RSR’, RSR’S’. Cardiac disease was reported in according with accepted international criteria. Results The mean age was 18.6±4.7 years. The majority were of white (71.3%) ethnicity. fQRS was observed in 1,546 (56.2%) male athletes and in 728 (26.5%; p<0.001) female athletes. The overall prevalence of fQRS in at least one ECG lead was 2,274 (42.7%). 720 (13.5%) demonstrated fQRS in two or more contiguous leads. fQRS was most commonly seen in lead V1 (25.5%), followed by III (15.7%), aVL (15.3%), and V3 (9.1%). Among 1,710 (32%) athletes who were screened more than once, 765 (44.5%) athletes manifested fQRS at the initial screening and 570 (74.5%) athletes (78.0% males and 55.2% females; p<0.001) demonstrated persistent fQRS in at least one ECG leads. 278 (16.3%) athletes (231 [19.1%] males and 47 [9.3%] females) manifested fQRS in two or more contiguous leads at the initial screening. Persistence of fQRS in two or more contiguous leads was more common in males vs females (60.6% vs 42.6%, p=0.034). Lateral fQRS (80.0%) was the most common persistent fQRS territory, compared to anterior (47.6%) and inferior (67.1%) fQRS. Among different fQRS patterns, the RSR’S’ pattern was the most persistent. There was no difference in the prevalence of cardiac pathology between athletes with persistent fQRS in at least one ECG leads and athletes without persistent fQRS (3.0% vs 2.1%; p=0.665). However, athletes with persistent fQRS in at least one ECG leads had a higher prevalence of cardiac pathology vs those without fQRS at the initial screening, (3.0% vs 0.8%; p=0.0015). There was a trend of a higher prevalence of cardiac pathology among athletes with persistent fQRS in two or more contiguous leads vs those without persistent fQRS (4.4% vs 1.7%; p= 0.365). Conclusion fQRS was more commonly observed in male athletes and more likely to persist over time compared to females. Persistence of fQRS over time was associated with cardiac pathology and was more likely to persist in the lateral leads, and with an RSR’S’ pattern. Such findings suggest ongoing surveillance for fQRS at initial screening of athletes.