Munther K. Homoud, MD, FACP, FACC, FHRS
Does prolonged PR interval or first-degree atrioventricular block (AVB) predict arrhythmia or mortality in ambulatory persons?
Cohort study (Framingham Heart Study) with ≤ 35 years of follow-up.
7575 participants ≥ 20 years of age (mean age 47 y, 54% women, 33% with hypertension) who had routine 12-lead electrocardiography (ECG). Exclusion criteria included prevalent atrial fibrillation (AF), history of AF or pacemaker implantation, and use of antiarrhythmic agents or cardiac glycosides.
PR interval and first-degree AVB (PR interval > 200 ms). Analyses were stratified by sex and prevalent cardiovascular disease (history of myocardial infarction, coronary insufficiency, stroke, or heart failure) and adjusted for age, heart rate, hypertension, body mass index, ratio of total to high-density lipoprotein cholesterol, smoking, and diabetes in all analyses; valve disease, ECG left ventricular hypertrophy, and atrial premature beats in AF analyses; and QRS interval in pacemaker analyses.
Incident AF, pacemaker implantation, and all-cause mortality.
1.6% of participants had AVB at baseline. Multivariate analysis showed that prolonged PR interval or AVB at baseline was associated with increased risk for AF, pacemaker implantation, and all-cause mortality (Table). 3% of participants developed AVB at 12 years and had increased risk for AF (adjusted hazard ratio [HR] 1.5, 95% CI 1.1 to 2.2) and pacemaker implantation (HR 2.7, CI 1.6 to 4.4) but not all-cause mortality.
Prolonged PR intervals were associated with increased risk for atrial fibrillation, pacemaker implantation, and mortality.
Association between PR interval at baseline and long-term clinical outcomes in adults*
*AVB = atrioventricular block; other abbreviations defined in Glossary. Hazard ratios stratified by sex and cardiovascular disease status and adjusted for age, heart rate, hypertension, body mass index, total to high-density lipoprotein cholesterol ratio, smoking, and diabetes in all analyses; valve disease, electrocardiographic left ventricular hypertrophy, and atrial premature beats in atrial fibrillation analyses; and QRS interval in pacemaker analyses.
†Hazard ratio for 1 standard deviation (20 ms) increments of PR interval.
‡First degree AVB = PR interval > 200 ms.
Homoud MK. Prolonged PR intervals were associated with increased risk for atrial fibrillation, pacemaker implantation, and mortality. Ann Intern Med. ;151:JC5–13. doi: 10.7326/0003-4819-151-10-200911170-02013
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Published: Ann Intern Med. 2009;151(10):JC5-13.
Cardiology, Rhythm Disorders and Devices.
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