Das et al evaluated the significance of fragmented, wide QRS in a 12-lead ECG. The authors are from Indiana University in Indianapolis.


Criteria for fragmented, wide QRS:

(1) wide indicates a QRS duration >= 120 milliseconds

(2) fragmented indicates 3 or more notches in the R or in the S waves in one or more of the following:

(2a) 2 or more continguous inferior leads (II, III, aVF)

(2b) 2 or more continguous lateral leads (I, aVL, V6)

(2c) 2 or more continguous anterior leads (V1, V2, V3, V4, V5, V6)



• The presence of 2 continuous leads corresponds to the territory of a major coronary artery.


The presence of fragmented, wide QRS waves in a patient with known or suspected coronary artery disease:

(1) indicates myocardial scar

(2) is associated with increased risk of mortality


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