Chanavuth KanitsoraphanPattara RattanawongPoemlarp MekraksakitPakawat ChongsathidkietTanawan RiangwiwatNapatt KanjanahattakijWasawat VutthikraivitSaranapoom KlomjitSubhanudh ThavaraputtaDuke University Medical CenterTexas Tech University Health Sciences Center at LubbockFaculty of Medicine, Ramathibodi Hospital, Mahidol UniversityUniversity of Hawaii at ManoaFaculty of Medicine, Siriraj Hospital, Mahidol UniversityPhramongkutklao College of MedicineEinstein Medical Center2020-01-272020-01-272019-03-01Annals of Noninvasive Electrocardiology. Vol.24, No.2 (2019)1542474X1082720X2-s2.0-85055042556https://repository.li.mahidol.ac.th/handle/20.500.14594/51839© 2018 Wiley Periodicals, Inc. Background: Recent studies suggested that fragmented (fQRS) is associated with poor clinical outcomes in heart failure with reduced ejection fraction (HFrEF) patients. However, no systematic review or meta-analysis has been done. We conducted a systematic review and meta-analysis to assess the association between baseline fQRS and all-cause mortality in HFrEF. Methods: We comprehensively reviewed the databases of MEDLINE and EMBASE from inception to February 2018. Published studies of HFrEF that reported fQRS and outcome of all-cause mortality and major arrhythmic event (sudden cardiac death, sudden cardiac arrest, ventricular fibrillation, or sustained ventricular tachycardia) were included. Data were integrated using the random-effects, generic inverse-variance method of DerSimonian and Laird. Results: Ten studies from 2010 to 2017 were included. Baseline fQRS was associated with increased all-cause mortality (risk ratio [RR] 1.63, 95% confidence interval [CI] 1.22–2.19, p < 0.0001, I 2  = 73%) as well as major arrhythmic events (RR = 1.74, 95% CI 1.09–2.80, I 2  = 89%). Baseline fQRS increased all-cause mortality in both Asian and Caucasian cohorts (RR = 2.17 with 95% CI 1.33–3.55 and RR = 1.45 with 95% CI 1.05–1.99, respectively) as well as increased major arrhythmic events in Asian cohort (RR = 1.50, 95% CI 1.05–2.13). Baseline fQRS also increased all-cause mortality in patients who had not received implantable cardioverter-defibrillator, significantly more than in patients who had received implantable cardioverter-defibrillator (RR = 2.46 with 95% CI 1.56–3.89 and 1.36 with 95% CI 1.08–1.71, respectively). Conclusion: Baseline fQRS is associated with increased all-cause mortality up to 1.63-fold in HFrEF patients. Fragmented QRS could be a predictor of clinical outcome in patients with HFrEF.Mahidol UniversityMedicineArticleSCOPUS10.1111/anec.12597