Patchy areas of cardiac fibrosis in the myocardium may interrupt the usually smooth process of depolarization in the ventricles and result in small high frequency notching in the QRS complex. Myocardial ischemia per se doesn't cause fibrosis unless subsequent myocardial infarction (cell death) follows and the subsequent scar affects the QRS complex morphology. Also inverted T waves aren't always due to myocardial ischemia.

there is Shirani method

Shirani J, Pick R, Guo Y, Silver MA. Usefulness of the electrocardiogram and echocardiogram in predicting the amount of interstitial myocardial collagen in endomyocardial biopsy specimens of patients with chronic heart failure. Am J Cardiol. 1992;69:1502-1503. [PubMed] [DOI] [Cited in This Article: 1] [Cited by in Crossref: 9] [Cited by in F6Publishing: 10] [Article Influence: 0.3] [Reference Citation Analysis (0)]

we have used this method in study with dilated CMP patients

Frank G Yanowitz Thank you very much doctor for your good answer.

Can you please introduce me some sources or articles?

Fragmentation of the QRS complex: the latest electrocardiographic craze?

Christian Brohet

Pages 185-187 | Received 14 Mar 2019, Accepted 22 Mar 2019, Published online: 05 Apr 2019 in Acta Cardiology

Several possibilities: decreased QRS amplitude, intraventricular conduction disorders (LAFB, LBBB, non-specific), fragmented QRS - depending on the location and extend/ amount.

Ljuba Bacharova

ECG changes in cardiac fibrosis depend on area of myocardium involve .If it involves Conductive pathway ,you will find conduction abnormalities .If it involve myocardium,may cause arrhythmias due to re-entry phenomena

Alok Kumar Bharti Ljuba Bacharova Frank G Yanowitz Hamayak Sisakian Thanks to you all for the great answers.

T wave inversion is not an ECG indicator of fibrosis. T wave inversion is the earliest sign of ischemia, well before any fibrosis enters the picture, so they are unrelated.