QRS Fragmentation

QRS fragmentation is when the normal waves have notching/irregularities. This is indicative of ventricular scarring, usually from prior MI; however, this can be from other myocardial diseases (cardiomyopathy). This usually occurs either at the nadir of the S wave or with an additional R' wave (2 R' waves) in 2 contiguous leads.

There are a few specific QRS fragmentation patterns. Cabrera's sign is a notch >50ms on the ascending limb of the S wave in a lead between V3-V5. Chapman's sign is a notch on the ascending limb of the R wave in a LBBB in either lead I, aVL, or V6. Chapman's sign has been studied to possibly diagnose acute MI as well.

Examples:

Further Reading:

http://hqmeded-ecg.blogspot.com/search/label/fragmented%20QRS

http://hqmeded-ecg.blogspot.com/search/label/Cabrera%27s%20sign

http://hqmeded-ecg.blogspot.com/search/label/Chapman%27s%20sign