共找到 20 条结果
Masquerading bundle branch block (MBBB) is a rare and underrecognized electrocardiographic pattern characterized by features of both right and left bundle branch block on the same tracing. Unlike typical bifascicular block, MBBB is increasingly recognized as a marker of advanced and often bilateral His-Purkinje system disease, with potential progression to high-grade atrioventricular block. We report the case of an 84-year-old woman with a history of atrial fibrillation, heart failure with preserved ejection fraction, chronic kidney disease, and aortic stenosis who presented with generalized weakness and severe hyponatremia. Electrocardiography (EKG) demonstrated atrial fibrillation with a wide QRS complex and right bundle branch block morphology in the precordial leads. Notably, there was absence of the expected terminal S wave in leads I and aVL with left axis deviation, consistent with masquerading bundle branch block. Comparison with prior electrocardiography revealed progression from bifascicular block to MBBB. During hospitalization, telemetry showed episodes of bradycardia with heart rates as low as 30 beats per minute, raising concern for advanced conduction system disease. The patient was managed conservatively and discharged with ambulatory rhythm monitoring and electrophysiology follow-up. MBBB represents a complex conduction disturbance often reflecting diffuse His-Purkinje system involvement rather than isolated right-sided conduction delay. It is frequently misclassified as right bundle branch block with left anterior fascicular block, leading to underrecognition of its clinical significance. Accumulating evidence suggests that MBBB is associated with a higher risk of progression to symptomatic bradyarrhythmias and advanced atrioventricular block. Recognition of its characteristic electrocardiographic features is essential for appropriate risk stratification and management, including consideration of prolonged monitoring or early electrophysiologic evaluation. Masquerading bundle branch block is an important but underrecognized electrocardiographic marker of advanced conduction system disease. Early identification may facilitate timely monitoring and intervention to prevent adverse outcomes related to conduction system failure.
Accurate ECG interpretation is an essential skill required for medical school graduation. Multiple choice question (MCQ) tests are widely used to assess student competence due to the feasibility of administration; however, many existing MCQs ECG tests lack strong validity evidence. Our study aimed to develop validity evidence for an MCQ based ECG assessment using Kane's validity framework. We analyzed the internal structure of a 22-item MCQ test. A modified Hofstee and Angoff method were used to set the passing standard. We compared MCQ scores with results from open-ended ECG quizzes to examine the relationship to a more "real-world" assessment. Pearson correlation coefficient and linear regression assessed the strength of the association between the two assessments and Welch's t-test compared open-ended scores between high and low MCQ performers. Eighteen of the 22 items met performance criteria. A passing score of 11/18 was set to reflect the desired failure rate of 0-10%. The Pearson correlation coefficient between MCQ and open-ended ECG scores was 0.414, indicating a moderate positive linear relationship. Linear regression showed an R2 of 0.19 between the two assessments. Students scoring in the lowest MCQ quartile had significantly lower open-ended scores (p < 0.001). These findings provide validity evidence for an MCQ assessment that identifies students below a minimum competency threshold. While the test effectively identifies struggling learners, it lacks the sensitivity to differentiate proficiency levels above that threshold. Future work should explore efficient methods for assessing and providing feedback on open-ended ECG interpretation.
Herein, we report a rare clinical case of competitive ventricular pacing caused by the accidental reactivation of a retained pacemaker two years after device replacement. Initially, two years following the implantation of the new pacemaker, the device demonstrated typical dual-chamber pacing. However, recent follow-up electrocardiography revealed two distinct QRS morphologies. Holter monitoring, imaging studies, and a review of prior procedural records confirmed that this phenomenon was caused by the unexpected reactivation of the retained pacemaker, leading to competitive ventricular pacing. A detailed analysis of the underlying causes of inadvertent reactivation led to the implementation of targeted interventions, which successfully resolved the issue of competitive ventricular pacing induced by dual pacemakers.
Noninvasive Electrocardiographic Imaging (ECGI) was used to define the mechanisms of atrial fibrillation (AF) in mitral regurgitation (MR), which remain poorly understood. Seventeen patients with degenerative MR and AF undergoing were studied. Thirteen age-matched patients with lone AF provided a control group. Epicardial electrograms were constructed noninvasively with ECGI using 256 body surface electrocardiograms and patient-specific heart-torso geometry from delayed-enhancement magnetic resonance imaging (DE-MRI) or computed tomography (CT) scans. Bi-atrial epicardial activation time maps and phase maps were generated. AF drivers were classified as focal (radial activation) or rotors (high curvature wavefront rotating about a center). Left atrial (LA) fibrosis was quantified from the DE-MRI scans in 5 MR patients. The LA and right atrium (RA) harbored 61% and 36% of drivers, respectively and the anterior inter-atrial groove had 3% of the sources. 51% of the drivers were mapped in the posterior LA. One third of drivers occurred repeatedly. The left PV and LA appendage regions had the most repetitive drivers. Activation patterns varied from single macro-reentry to simultaneous wavelets resulting in wave breaks and collisions. Driver distribution and activation patterns remained similar between MR and lone AF groups, except stable rotors were not observed in MR. DE-MRI maps showed bi-atrial fibrosis. Drivers and discontinuous wavefront propagation were often localized in fibrotic regions. AF activation patterns in MR were complex and exhibited spatio-temporal variability. Bi-atrial drivers were present. The posterior LA harbored the highest percentage of drivers. This region also exhibited fibrosis in a subset of patients, suggesting that it may play a role in creating the AF substrate.
Acute myocardial infarction (MI) remains one of the major causes of morbidity and mortality throughout the world. The objectives of this study were to determine the diagnostic agreement between the findings from Portable (Spandan Pro) and Conventional Electrocardiogram with coronary angiography (CAG) regarding vessel involvement in MI patients, and to assess related risk factors. This study was an Observational, Single-arm, Cross-sectional study performed on 109 subjects at a local hospital in Dehradun. The study was approved by the Institutional Ethics Committee, and informed consent was obtained from all the participants. For diagnostic agreement, Statistical analyses such as Cohen's κ, weighted κ, prevalence- and bias-adjusted κ (PABAK), and Jaccard index were used. The mean age of the included patients was 58 ± 11.96 years, with a significant male predominance (88.07%). For overall vessel involvement of ECGs with CAG, portable ECG showed a higher sensitivity (84.76 vs. 78.10%), and for LAD artery, it also showed higher sensitivity (88.46% vs. 82.05%) compared to the conventional ECG. Diagnostic agreement showed substantial agreement with CAG (PABAK 0.68), and according to the Jaccard Index, there was a moderate agreement (approximately 50%) between the ECG-derived findings with CAG across all types of vessel diseases. The most prevalent confounding factor among the participants was smoking (41.9%), followed by Hypertension (39.0%) and diabetes (34.3%). This study indicates that Portable ECG performed comparably to conventional ECG and had a moderate level of diagnostic agreement with CAG in the detection of vessel involvement in patients with MI.
ECG manifestations of aortic valve Infective endocarditis are rare and typically consist of evidence of AV dysfunction - from 1st degree AV block to complete heart block. We present an interesting ECG in a gentleman with E faecalis bacteraemia, in the setting of aortic root abscess. An 80-year-old male with a past medical history of a bioprosthetic valve and ascending aorta replacement presented to the hospital with generalized malaise, poor oral intake, febrile to 39 °C and dyspnoea. He grew Enterococcus faecalis in his blood cultures and imaging of his chest, abdomen and pelvis was unremarkable. His ECG demonstrated new onset Wenckebach physiology and subsequent transesophageal echocardiography revealed an aortic root abscess. He was referred with an ECG of atrial bigeminy with 1st degree AV block, but upon closer review, there are several other key findings. Firstly, his ECG demonstrates Wenckebach physiology with a consistent PP interval of 560 ms. However, his ECG exhibits more than just Wenckebach in that the first QRS has a more aberrant appearance than the second one. We postulate this is due to Gap phenomenon where there are functional differences in conduction properties in proximal and distal components of the AV node and phase 4 conduction block where a period of nonconduction due to a blocked P wave results in a reduced responsiveness of Purkinje/bundle branch conducting tissues. Thus, the first QRS (130 ms) appears more aberrant than the second (100 ms). This case highlights the importance of identifying AV dysfunction in septic patients whilst demonstrating an interesting ECG and the importance of recognizing Wenckebach which may have a subtle appearance.
Accurate risk stratification is crucial for managing patients with coronary heart disease (CHD). This study aimed to investigate the value of baseline electrocardiogram (ECG) indicators in predicting one-year major adverse cardiovascular events (MACE) in patients with CHD. This single-center, retrospective cohort study enrolled 200 hospitalized patients with a confirmed CHD diagnosis. Baseline demographic, clinical, echocardiographic, and 12-lead ECG data were collected. The primary endpoint was the occurrence of MACE (a composite of cardiac death, non-fatal acute MI, severe arrhythmia, severe heart failure, and stroke) within one year. Univariate and multivariable logistic regression analyses were performed to identify independent ECG predictors, with predictive performance evaluated using receiver operating characteristic (ROC) curve analysis. During a one-year follow-up, 29 of 200 patients (14.5%) experienced a MACE. Patients with MACE had significantly worse baseline cardiac function, including lower left ventricular ejection fraction (LVEF) and higher E/e' ratio. In multivariable analysis, higher resting heart rate (OR per 10 bpm: 1.54, 95% CI: 1.09-2.17, P=0.014), longer QRS duration (OR per 10 ms: 1.69, 95% CI: 1.16-2.47, P=0.006), and longer corrected QT (QTc) interval (OR per 10 ms: 1.63, 95% CI: 1.23-2.15, P<0.001) were independent predictors of MACE. A combined model integrating these three parameters demonstrated excellent predictive accuracy (AUC=0.85, 95% CI: 0.78-0.92), superior to any single parameter. The QTc interval was the best single predictor (AUC=0.79). Higher resting heart rate, longer QRS duration, and longer QTc interval are independent and powerful predictors of one-year MACE in patients with CHD. A combined model using these simple ECG markers provides robust risk stratification, offering significant incremental predictive value over baseline clinical factors.
Electrocardiographic (ECG) analysis becomes challenging in the presence of concurrent ventricular preexcitation (WPW) and right bundle branch block (RBBB) due to their mutually interfering ECG manifestations. Interpolated ventricular premature contractions (IPVCs) can transiently alter the conduction velocity and refractory period of the WPW accessory pathway and the His-Purkinje system, thereby leading to intermittent manifestation of WPW or RBBB. In Case 1 and Case 2, IPVCs converted sinus beats from the WPW + RBBB pattern to the pure RBBB pattern; in Case 3, sinus beats after IPVCs changed from the pure WPW pattern to the WPW + RBBB pattern. Full utilization of such valuable dynamically emerging information, together with a thorough and systematic examination of the ECG including the dissection of the initial, middle, and terminal electrical forces of the QRS complex, is crucial for an accurate diagnosis.
Electrocardiographic (ECG) markers of atrial cardiomyopathy obtained in sinus rhythm may help identify outpatients at increased risk of incident atrial fibrillation (AF) and related adverse outcomes. To evaluate the associations of P-wave terminal force in lead V1 (PTFV1) and deep terminal negativity of the P wave in V1 (DTNPV1) with incident AF and clinical outcomes in a contemporary outpatient cohort. We conducted a retrospective cohort study of consecutive adults undergoing clinically indicated outpatient 12‑lead ECG in sinus rhythm between September 2022 and September 2025. Abnormal PTFV1 was defined as ≥4000 μV·ms and DTNPV1 as a biphasic P wave in V1 with terminal negative amplitude >100 μV. The primary endpoint was incident AF, defined as the first new AF episode after the index ECG requiring objective rhythm documentation on a 12‑lead ECG/rhythm strip or ambulatory monitor report (≥30 s); diagnostic codes alone were not sufficient. Secondary endpoints were incident ischemic stroke/TIA, heart failure (HF) hospitalization, all-cause mortality, and a composite outcome. Associations were assessed using Cox proportional hazards models with prespecified multivariable adjustment. The final cohort included 1500 patients; 400 (26.7%) had abnormal PTFV1. Over a median follow-up of 3.2 years, incident AF occurred in 301 patients (20.1%). AF incidence was higher in the abnormal vs normal PTFV1 groups (31.0% vs 16.1%), and abnormal PTFV1 independently predicted incident AF (adjusted HR 1.35, 95% CI 1.03-1.77). Abnormal PTFV1 was also associated with incident stroke/TIA (7.8% vs 4.0%; adjusted HR 1.34, 95% CI 1.01-1.78), incident HF hospitalization (17.5% vs 10.0%; adjusted HR 1.22, 95% CI 1.01-1.48), and the composite endpoint (37.5% vs 30.0%; adjusted HR 1.28, 95% CI 1.10-1.48). All-cause mortality was numerically higher but not statistically significant after adjustment (6.3% vs 4.5%; adjusted HR 1.35, 95% CI 0.82-2.21). DTNPV1 was not independently associated with incident AF after adjustment. In outpatients with sinus-rhythm ECGs, abnormal PTFV1 is independently associated with higher risk of incident AF and other clinically relevant outcomes, supporting its potential role in targeted rhythm surveillance and risk stratification.
Left bundle branch area pacing (LBBAP) is increasingly used to achieve physiologic ventricular activation. However, electrical "success" may differ by baseline substrate: resynchronization in left bundle branch block (LBBB) versus preservation of synchrony in intrinsically narrow QRS. Ultra-high-frequency ECG (UHF-ECG) provides quantitative indices of ventricular activation timing and dispersion beyond QRS duration. We report a contrastive two-case series undergoing dual-chamber pacing with an LBBAP lead. Pre- and post-implant UHF-ECG was analyzed using ventricular depolarization maps and dyssynchrony indices, including ventricular electrical delay (VED) and mean ventricular dispersion (MeanVD). Conventional ECG timing metrics were assessed in parallel (QRS duration when available, R-wave peak time [RWPT], and inter-peak intervals). Global RWPT was calculated as the sum of RWPT in lead I and lateral precordial lead (V5/6 or V6, depending on availability). In Case 1 (baseline complete LBBB), LBBAP resulted in a resynchronization phenotype with QRS duration reduction from 201.6 ms to 137.6 ms, VED16 improvement from +48 ms to -5 ms, and MeanVD16 reduction from 85 ms to 66 ms. RWPT(V5/6) was 90.0 ms and RWPT(I) 96.8 ms, yielding a global RWPT of 186.8 ms. In Case 2 (baseline narrow QRS), UHF-ECG demonstrated preservation of synchrony with stable VED18 (-3 ms pre- and post-implant) and low MeanVD18 (25 ms to 24 ms), alongside RWPT(V6) 87.6 ms and RWPT(I) 56.0 ms (global RWPT 143.6 ms). UHF-ECG provided reproducible, quantitative descriptions in both cases and was demonstrative of two clinically relevant response patterns after LBBAP (resynchronization in baseline LBBB and preservation of low dyssynchrony in baseline narrow QRS). These findings are descriptive and warrant confirmation in larger cohorts.
Current guidelines classify acute coronary syndrome (ACS) into unstable angina (UA), ST-segment elevation myocardial infarction (STEMI), and non-ST-segment elevation myocardial infarction (NSTEMI). However, this classification pattern may lead to inadequate recognition of acute coronary occlusion (ACO), particularly when electrocardiographic (ECG) findings are atypical. An increasing number of "STEMI-equivalent" ECG patterns are considered significant features of ACO. The Aslanger's pattern is regarded as indicative of right coronary artery (RCA)-related inferior wall myocardial infarction, while the de Winter's pattern is considered an STEMI-equivalent manifestation of acute left anterior descending (LAD) occlusion. This article reports two cases of ACS patients who exhibited both Aslanger's and de Winter's patterns on admission ECG, but coronary angiography confirmed acute lesions in the left coronary artery system. The Aslanger's pattern is not a specific manifestation of RCA lesions. When co-occurring with de Winter patterns, heightened vigilance for acute left coronary artery lesions is warranted. Identifying such patterns holds significant clinical importance for avoiding delays in reperfusion therapy.
Fever is a common cause of emergency department admission and may induce transient alterations in cardiac electrophysiology. P-wave dispersion (PWD), a noninvasive marker of atrial conduction heterogeneity, is associated with an increased risk of supraventricular arrhythmias, particularly atrial fibrillation. To evaluate the effect of acute fever on P-wave dispersion and related atrial conduction parameters in patients without known structural heart disease, using a within-subject comparison between febrile and afebrile states. This single-center, prospective observational study was conducted in the emergency department of a tertiary care hospital between December 2024 and April 2025. Adult patients (≥18 years) with a body temperature > 37.9 °C were included. Twelve‑lead electrocardiograms were obtained during the febrile period at presentation and after defervescence. Maximum P-wave duration (Pmax), minimum P-wave duration (Pmin), and P-wave dispersion (PWD) were calculated. A total of 216 patients were enrolled. Median body temperature decreased from 38.3 (38-39) °C before treatment to 36.9 (36.6-37.1) °C after treatment (p < 0.001). During fever, Pmax, Pmin, and PWD values were significantly higher than those measured after defervescence (Pmax: 89 vs. 80 ms; Pmin: 40 vs. 40 ms; PWD: 48 vs. 40 ms; p < 0.001). A weak positive correlation was observed between changes in body temperature and Pmax (ρ = 0.135; p = 0.048), with no significant association for Pmin or PWD. Acute fever was associated with transient alterations in P-wave dispersion and atrial conduction parameters. These changes appeared to be reversible following fever resolution. The potential clinical and arrhythmic implications of these findings remain to be clarified and warrant further investigation.
Septic shock remains a leading cause of mortality in critically ill patients. Electrocardiography (ECG) is a rapid, non-invasive tool, and the T-wave to R-wave amplitude ratio (T/R ratio) has been proposed as a marker of electrolyte disturbances and myocardial stress. Its prognostic value in septic shock, however, is unclear. To evaluate the association between the admission T/R ratio and short-term mortality in patients with septic shock and to identify independent predictors of mortality. We conducted a single-center, retrospective observational study of 319 adult patients diagnosed with septic shock who had a 12‑lead ECG on admission. T and R wave amplitudes were manually measured in leads II and V5, and the T/R ratio was calculated. Demographic, clinical, and laboratory data were collected. Multivariable logistic regression was used to identify independent predictors of in-hospital mortality. Among 319 patients, 214 (67.1%) experienced in-hospital mortality. The T/R ratio was not significantly associated with mortality in univariable or multivariable analyses. Independent predictors of mortality included advanced age (OR, 1.04; 95% CI, 1.01-1.07), elevated white blood cell count (OR, 1.06; 95% CI, 1.00-1.11), hypoalbuminemia (OR, 0.89; 95% CI, 0.84-0.94), hyperkalemia (OR, 1.53; 95% CI, 1.01-2.31), abnormal T wave axis (OR, 1.01; 95% CI, 1.00-1.01), and heart failure (OR, 3.92; 95% CI, 1.35-10.85). The regression model demonstrated good predictive performance (accuracy 75.9%, sensitivity 88.9%, specifically 44.3%, AUC 0.816). The T/R ratio on admission ECG does not reliably predict short-term mortality in patients with septic shock. Mortality is primarily driven by established clinical and laboratory predictors. ECG-derived indices may provide complementary information but should be interpreted alongside clinical scoring systems and biochemical markers to improve risk stratification and guide management in this high-risk population.
ST-segment elevation myocardial infarction (STEMI) and its equivalents describe the electrocardiogram (ECG) findings of acute coronary occlusion myocardial infarction (OMI). Discordance in ECG interpretation between Emergency Medicine and Cardiology teams is common. We examined the utility of an artificial intelligence (AI) algorithm to improve diagnostic accuracy for OMI in the difficult subset of canceled STEMI activations. We conducted a retrospective review of STEMI activations over 17 months. We included cases that were canceled with the rationale of "ECG not meeting STEMI criteria." We excluded sustained activations, cancellations with alternative rationales, and incomplete records. OMI was defined as an angiographic culprit lesion with TIMI 0 or 1 flow. ECGs were reviewed by the AI algorithm and assessed for STEMI criteria. Of 1224 STEMI activations, 185 cancellations (15.1%) were included, with 17 patients meeting the study definition of OMI. STEMI criteria demonstrated lower sensitivity for OMI as compared to the AI algorithm (47.1% vs 94.1%, p = 0.005), and a non-significantly lower specificity (66.1% vs 73.2%, p = 0.090). The AI algorithm also demonstrated higher positive and negative likelihood ratios for OMI identification (3.51 and 0.08, respectively) than STEMI criteria (1.39 and 0.80, respectively). Our data suggests that the AI algorithm may serve as a clinical adjunct to improve interrater reliability between Emergency Medicine and Cardiology teams in OMI identification. Further prospective studies may help evaluate its utility in clinical practice.
We report a case of drug-refractory ventricular tachycardia (VT) triggered by left lateral and supine positions, with only one prior case reported. The patient's VT originated from the moderator band(MB) and occurred in the left lateral and supine positions, but stopped when in the right lateral position. Symptoms disappeared after the patient experienced catheter ablation targeting the head end of the MB. We found that the clinical characteristics of VT originating from the MB could be manifested on electrocardiogram. The mechanism of posture-induced VT may be related to the effect of ventricular pressure on calcium channels and may be related to the age of the patient.
The diagnostic accuracy of electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in Taiwanese adults remains uncertain, particularly in the presence of complete right bundle branch block (CRBBB). We retrospectively enrolled 431 Taiwanese adults, including 205 with normal conduction and 226 with CRBBB. Echocardiographic left ventricular mass index (LVMI) served as the reference standard. We evaluated the sensitivity, specificity and area under the receiver operating characteristic curve (AUC) of six traditional ECG criteria: Sokolow-Lyon index, RaVL, modified Sokolow-Lyon, Cornell voltage, Gubner-Ungerleider and Peguero-Lo Presti. Linear regression examined associations between individual ECG parameters and LVMI, with a focus on the impact of CRBBB. Exploratory analyses were conducted to derive novel ECG indices. Traditional ECG criteria showed low sensitivity but high specificity overall. In patients with normal conduction, Cornell voltage performed best in females and Gubner-Ungerleider in males. However, diagnostic performance decreased substantially in the presence of CRBBB, particularly for criteria relying on anteroseptal leads. In CRBBB patients, QRS duration demonstrated stronger correlation with LVMI than voltage-based criteria. In our cohort, ECG criteria with superior performance is SD× QRS (AUC 0.754) in males with CRBBB, QRS duration (AUC 0.868) in CRBBB females and BMI<24, and SV4 amplitude (AUC 0.702) in CRBBB females with BMI≥ 24. Traditional ECG criteria for LVH originally developed in Western cohorts demonstrated limited diagnostic performance in Taiwanese adults, particularly in the setting of CRBBB. QRS duration and derived indices may provide more accurate alternatives for detecting LVH in this population.
The 12‑lead electrocardiogram (ECG) remains a cornerstone of cardiovascular assessment, providing a noninvasive window into cardiac electrical and structural function beyond other markers of ischemia and arrhythmias. P-wave peak time (PWPT), defined as the interval from P-wave onset to its maximal amplitude, has emerged as a novel electrocardiographic marker of atrial conduction and hemodynamic stress. Increasing evidence suggests that PWPT prolongation accompanies elevated ventricular filling pressures, atrial stretch, and chronic atrial remodeling across a spectrum of ischemic conditions, including both obstructive coronary artery disease and ischemia with no obstructive coronary arteries (INOCA). In addition to serving as a marker of acute ischemia, PWPT also appears to capture long-term atrial structural and electrophysiologic changes, including fibrosis and conduction slowing. These same processes are central to the development of atrial fibrillation, providing a biologically plausible link between PWPT prolongation and arrhythmogenic risk. Moreover, given its simplicity and compatibility with computerized ECG analysis, PWPT represents a promising adjunctive marker for cardiovascular risk stratification. Further investigation in larger and more diverse populations is warranted to define its prognostic significance and clinical utility.
This short communication aims at raising an insight about an observation made 26 years ago, describing a transient false positive electrocardiogram (ECG)-based diagnosis of left ventricular hypertrophy (LVH) in patients with various tachycardias (e.g, sinus, supraventricular, atrial fibrillation) with or without evidence of LVH as assessed by cardiac imaging. The mechanism is purported to be due to a tachycardia-mediated shortening of the diastolic left ventricular (LV) dimensions due to tachycardias, with the diastolic LV volume centroid displaced closer to the anterior chest wall (e.g. "Wilson's proximity effect"). This insight prevents an inappropriate diagnosis of LVH; also, it is possible that the absence of such a phenomenon during tachycardias may imply in some cases advanced acute or chronic heart failure, resulting in LV diastolic dilatation, counteracting this ECG phenomenon. The author advocates that automated ECG interpretation algorithms providing interpretation upon recording of an ECG should be modified to reflect on this insight, since many physicians rely inappropriately on the automated ECG interpretation.
Fragmented QRS (fQRS) complexes have been associated with myocardial conduction abnormalities and arrhythmic risk in various cardiac conditions. However, their clinical significance in patients with isolated hypertension, particularly in relation to ventricular arrhythmia burden and autonomic dysfunction, remains incompletely understood. This study aimed to investigate the association between fQRS, ventricular arrhythmia burden, left ventricular geometry, and cardiac autonomic function in these patients. This retrospective observational study included 229 patients with isolated hypertension who underwent 24-h rhythm Holter monitoring and ambulatory blood pressure monitoring. Patients were classified according to the presence of fQRS on standard 12‑lead electrocardiography. Ventricular arrhythmias were evaluated using Holter recordings and classified according to the Lown classification system. Cardiac autonomic function was assessed using heart rate variability (HRV) and heart rate turbulence (HRT) parameters. Echocardiographic evaluation was performed to assess left ventricular mass and geometry. Comparisons were made between patients with and without fQRS, and multivariable logistic regression analysis was used to identify independent predictors of higher arrhythmia burden. fQRS was present in 101 patients (44.1%) who demonstrated significantly higher ventricular and atrial ectopic burden and were more frequently classified into higher Lown arrhythmia classes compared with those without fQRS (p < 0.001). Echocardiographic assessment revealed greater left ventricular mass index and a higher prevalence of concentric hypertrophy in patients with fQRS. Standard HRV parameters (SDNN and RMSSD) as well as the variability index (%), were significantly lower in the fQRS group, and impaired HRT was observed exclusively among these patients. Non-dipper heart rate pattern was also significantly more frequent in patients with fQRS. In multivariable analysis, lower SDNN values, the presence of fQRS, concentric hypertrophy, and non-dipper heart rate pattern emerged as independent predictors of higher Lown classification. In patients with isolated hypertension, fQRS is associated with increased ventricular arrhythmia burden, adverse left ventricular remodeling, and objective markers of autonomic dysfunction.