Scenario: This is a resting 12-lead ECG from a 72-year-old man visiting the Veterans Administration for his annual checkup. Because he has left ventricular dysfunction (ejection fraction <35%), he is at risk for sudden cardiac death. Given the patient’s history, an implantable cardiac defibrillator was placed that has not yet discharged. Currently, he has no complaints.

Normal sinus rhythm with QRS fragmentation in the inferior leads (II, III, aVF) and V5, V6

Due to recent improvements in aggressive management of acute myocardial infarction (MI), fewer patients are sustaining transmural (entire wall thickness) infarction that results in classic Q waves on the ECG. Current literature reports that fragmented QRS (fQRS) may be a marker of altered ventricular depolarization due to prior MI scar. Thus, fQRS may be an alternative ECG marker to the q wave in non–Q wave MI among patients who do not suffer transmural injury. As...

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