Diffuse Fragmented QRS as an Index of Extensive Myocardial Scar

A 70-year-old man with history of previous myocardial infarction was referred for cardiac resynchronization therapy (CRT) implantation. Echocardiography showed global wall motion abnormality and non-viable myocardium with ejection fraction of 15% and large apical aneurysm. Electrocardiography (ECG) revealed sinus rhythm with wide QRS (200 ms). Of note is the finding of marked fragmentation of QRS in limb leads and V4 - V6.