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7162454 
Journal Article 
Inter- and intra-observer variability of visual fragmented QRS scoring in ischemic and non-ischemic cardiomyopathy 
Vandenberk, B; Willems, Rik; Robyns, T; Goovaerts, G; Claeys, M; Helsen, F; Van Soest, S; Garweg, C; Ector, J; Van Huffel, S; , 
2018 
Yes 
Journal of Electrocardiology
ISSN: 0022-0736
EISSN: 1532-8430 
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS 
PHILADELPHIA 
549-554 
29275955 
WOS:000434104700043 
Background: Fragmented QRS (fQRS) on a 12-lead ECG has been linked with adverse outcome. However, the visual scoring of ECGs is prone to inter- and intra-observer variability.Methods: Five observers, two experienced and three novel, assessed fQRS in 712 digital ECG5, 100 were reevaluated to assess intra-observer variability. Fleiss and Cohen's Kappa were calculated and compared between subgroups.Results: The inter-observer variability for assessing fQRS in all leads combined was substantial with a Kappa of 0.651. Experienced observers only had a better agreement with a Kappa of 0.823. Intra-observer variability ranged from 0.736 to 0.880. In the subgroup with ventricular pacing the inter-observer variability was even significantly larger when compared to ECG5 with normal QRS duration (Kappa 0.493 vs 0.664, p < 0.001).Conclusion: The visual assessment of QRS fragmentation is prone to inter- and intra-observer variability, mainly influenced by the experience of the observers, the underlying rhythm and QRS morphology. (C) 2017 Elsevier Inc. All rights reserved.