Wide QRS Width a Predictor for Poor Outcomes Among Patients With Atrial Fibrillation

A study was conducted to determine the relationship between QRS duration and risk for poor clinical outcomes in patients with atrial fibrillation.

Prolonged QRS has been found to be an independent predictor for adverse outcomes among patients with atrial fibrillation (AF), according to results of a study published in The American Journal of Cardiology.

Data for this study were sourced from the Keio Interhospital Studies-Atrial Fibrillation (KiCS-AF) registry which collected information from patients with prevalent or incident AF at 11 hospitals in Japan between 2012 and 2018. Risk for poor clinical outcomes was evaluated on the basis of QRS duration. Wide QRS duration was defined as 120 minutes or longer.

Patients were stratified by narrow (n=2967) and wide (n=302) QRS widths. The narrow and wide cohorts comprised 67.7% and 74.2% men (P =.022); aged median 69 (IQR, 60-76) and 74 (IQR, 67-79) years (P <.001); diastolic blood pressure was 76 (IQR, 68-85) and 74 (IQR, 66-83) mm Hg (P =.003); and 1.1% and 9.6% had an implantable cardiac device (P <.001), respectively.

The wide QRS cohort was associated with an increased incident rate of the composite outcome of all-cause mortality and heart failure (HF) admission at 2 years (13.1%) compared with the narrow QRS cohort (4.9%; P <.001). Similarly, the wide cohort associated with higher rates of both all-cause mortality (5.9% vs 1.8%; P <.001) and HF admission (8.0% vs 3.4%; P <.001) events, respectively.

In a subgroup analysis, risk for wide QRS was associated with ablation within 2 years (adjusted hazard ratio [aHR], 4.17; 95% CI, 1.24-14.0), no history of congestive heart failure (aHR, 2.45; 95% CI, 1.43-4.21), age younger than 75 years (aHR, 2.25; 95% CI, 1.03-4.91), nonspecific conduction disturbance (aHR, 1.95; 95% CI, 1.08-3.52), and male gender (aHR, 1.74; 95% CI, 1.08-2.82).

Significant changes to AF effect on quality of life scores were observed among both the narrow and wide QRS cohorts overall as well as on symptoms, daily activities, treatment concerns, and satisfaction subscores (all P £.006), with greater negative effects observed among the wide QRS cohort.

This study may be limited by not having access to data about mechanical dyssynchrony.

“…a prolonged QRS [duration] is an independent risk factor for adverse outcomes,” the study authors noted. “Careful assessment of the QRS [duration] may help identify patients with AF at high risk of serious complications and [health-related quality of life] deterioration.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Miyama H, Ikemura N, Kimura T, et al. Implications of QRS prolongation in patients with atrial fibrillation (from a multicenter outpatient registry). Am J Cardiol. Published online July 7, 2022. doi:10.1016/j.amjcard.2022.05.011