Fragmented QRS predicts 2-year mortality in patients undergoing transfemoral-transcatheter aortic valve replacement: a retrospective observational study.

Background Transcatheter aortic valve replacement (TAVR) is a well-established therapeutic strategy in high-risk patients with severe aortic stenosis. The aim of this study was to analyze the prognostic value of the fragmented QRS morphology (fQRS) on 12-lead electrocardiography (ECG) for predicting 2-year mortality in patients who underwent TAVR. Methods A total of 272 patients (median age; 84 years, 68.4% female) undergoing the TAVR approached from the femoral artery between 2016 and 2020 were included in this retrospective cohort study. Patients were assigned into two groups based on the presence or absence of fQRS on 12-lead ECG before the procedures. Independent predictors of 2-year mortality were evaluated using Cox regression and Kaplan-Meier survival analysis. Results During the study period, in total, 272 patients were assigned into two groups based on the presence (n = 108) and the absence (n = 164) of fQRS on 12-lead ECG before TAVR procedures. All-cause mortality was higher in the fQRS group (34 [31.5%]) than in the non-fQRS group (5 [3%]) during a mean follow-up of 21.9 months. Kaplan-Meier survival analysis revealed significantly lower all-cause mortality in the non-fQRS group (p < 0.001). The independent predictor of 2-year mortality at follow-up in multivariate Cox regression analysis was the presence of fQRS (hazard ratio, 1.371; 95% confidence interval, 1.072–1.754; p = 0.012). Severe mitral valve regurgitation and paravalvular leakage did not independently predict 2-year mortality. Conclusions The presence of fQRS on 12-lead ECG was an independent predictor of 2-year survival in patients undergoing TAVR. The fQRS may serve as a valuable factor to identify patients with higher risk who will need close follow-up and more intense treatment after TAVR surgery.