Prolonged PR Interval and Incidence of Atrial Fibrillation, Heart Failure Admissions, and Mortality in Patients with Implanted Cardiac Devices: A Real-world Survey

Overview

Journal Heart Rhythm O2

Date 2023 Mar 30

PMID 36993911

Authors

Hirad Yarmohammadi

Elaine Y Wan

Angelo Biviano

Hasan Garan

Jodi L Koehler

Robert W Stadler

Affiliations

Soon will be listed here.

Abstract

Background: Prolongation of the PR interval has long been considered a benign condition, particularly in the setting of nonstructural heart disease.

Objective: The purpose of this study was to investigate the effect of PR interval on various well-adjudicated cardiovascular outcomes using a large real-world population data of patients with implanted dual-chamber permanent pacemakers or implantable cardioverter-defibrillators.

Methods: PR intervals were measured during remote transmissions in patients with implanted permanent pacemakers or implantable cardioverter-defibrillators. Study endpoints (time to the first occurrence of AF, heart failure hospitalization [HFH], or death) were obtained between January 2007 and June 2019 from the deidentified Optum de-identified Electronic Health Record dataset.

Results: A total of 25,752 patients (age 69.3 ± 13.9 years; 58% male) were evaluated. The average intrinsic PR interval was 185 ± 55 ms. In the subset of 16,730 patients with available long-term device diagnostic data, a total of 2555 (15.3%) individuals developed AF during 2.59 ± 2.18 years of follow-up. The incidence of AF was significantly higher (up to 30%) in patients with a longer PR interval (ie, PR interval ≥270 ms; .05). Time-to-event survival analysis and multivariable analysis showed that PR interval ≥190 ms was significantly associated with higher incidence of AF, HFH, or HFH or death when compared with shorter PR intervals ( .05 for all 3 parameters).

Conclusion: In a large real-world population of patients with implanted devices, PR interval prolongation was significantly associated with increased incidence of AF, HFH, or death.

Citing Articles

Association of electrocardiogram features with risk of obstructed sleep apnea: a population-based cohort study.

Wu C, Huang J, Huang M, Tan Y, Chen C, Zheng M Sleep Breath. 2025; 29(1):96.

PMID: 39934598 DOI: 10.1007/s11325-025-03266-7.

Vascular function assessed by flow-mediated vasodilation and nitroglycerine-induced vasodilation in subjects with first-degree atrioventricular block.

Mizobuchi A, Maruhashi T, Saito Y, Yamaji T, Harada T, Yusoff F Sci Rep. 2024; 14(1):30315.

PMID: 39638866 PMC: 11621448. DOI: 10.1038/s41598-024-81211-6.

Association of same-day urinary phenol levels and cardiac electrical alterations: analysis of the Fernald Community Cohort.

Rubinstein J, Pinney S, Xie C, Wang H Environ Health. 2024; 23(1):76.

PMID: 39300535 PMC: 11412060. DOI: 10.1186/s12940-024-01114-x.

Association of same-day urinary phenol levels and cardiac electrical alterations: analysis of the Fernald Community Cohort.

Rubinstein J, Pinney S, Xie C, Wang H Res Sq. 2024; .

PMID: 38853936 PMC: 11160919. DOI: 10.21203/rs.3.rs-4445657/v1.

Can prolonged P-R interval predict clinical outcomes in non-ST elevation acute coronary syndrome patients?.

Zareei M, Zareiamand H, Kamali M, Ardalani N, Ebrahimi A, Nabati M BMC Cardiovasc Disord. 2024; 24(1):137.

PMID: 38431589 PMC: 10909255. DOI: 10.1186/s12872-024-03809-y.

References

Kwok C, Rashid M, Beynon R, Barker D, Patwala A, Morley-Davies A . Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes: a systematic review and meta-analysis. Heart. 2016; 102(9):672-80. DOI: 10.1136/heartjnl-2015-308956. View

Mason J, Ramseth D, Chanter D, Moon T, Goodman D, Mendzelevski B . Electrocardiographic reference ranges derived from 79,743 ambulatory subjects. J Electrocardiol. 2007; 40(3):228-34. DOI: 10.1016/j.jelectrocard.2006.09.003. View

Schumacher K, Buttner P, Dagres N, Sommer P, Dinov B, Hindricks G . Association between PR interval prolongation and electro-anatomical substrate in patients with atrial fibrillation. PLoS One. 2018; 13(11):e0206933. PMC: 6218078. DOI: 10.1371/journal.pone.0206933. View

Wilkoff B, Cook J, Epstein A, Greene H, Hallstrom A, Hsia H . Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA. 2003; 288(24):3115-23. DOI: 10.1001/jama.288.24.3115. View

Ellenbogen K, Freedman R, Gettes L, Gillinov A, Gregoratos G, Hayes D . 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice.... J Am Coll Cardiol. 2012; 61(3):e6-75. DOI: 10.1016/j.jacc.2012.11.007. View

Nielsen J, Pietersen A, Graff C, Lind B, Jan Struijk J, Olesen M . Risk of atrial fibrillation as a function of the electrocardiographic PR interval: results from the Copenhagen ECG Study. Heart Rhythm. 2013; 10(9):1249-56. DOI: 10.1016/j.hrthm.2013.04.012. View

Dilaveris P, Farbom P, Batchvarov V, Ghuran A, Malik M . Circadian behavior of P-wave duration, P-wave area, and PR interval in healthy subjects. Ann Noninvasive Electrocardiol. 2001; 6(2):92-7. PMC: 7027634. DOI: 10.1111/j.1542-474x.2001.tb00092.x. View

Kruse I, Arnman K, Conradson T, Ryden L . A comparison of the acute and long-term hemodynamic effects of ventricular inhibited and atrial synchronous ventricular inhibited pacing. Circulation. 1982; 65(5):846-55. DOI: 10.1161/01.cir.65.5.846. View

Hsu J, Birnie D, Stadler R, Cerkvenik J, Feld G, Birgersdotter-Green U . Adaptive cardiac resynchronization therapy is associated with decreased risk of incident atrial fibrillation compared to standard biventricular pacing: A real-world analysis of 37,450 patients followed by remote monitoring. Heart Rhythm. 2019; 16(7):983-989. DOI: 10.1016/j.hrthm.2019.05.012. View

10.

Erikssen J, Otterstad J . Natural course of a prolonged PR interval and the relation between PR and incidence of coronary heart disease. A 7-year follow-up study of 1832 apparently healthy men aged 40-59 years. Clin Cardiol. 1984; 7(1):6-13. DOI: 10.1002/clc.4960070104. View

11.

Agarwal Y, Aronow W, Levy J, Spodick D . Association of interatrial block with development of atrial fibrillation. Am J Cardiol. 2003; 91(7):882. DOI: 10.1016/s0002-9149(03)00027-4. View

12.

Ishikawa T, Kimura K, Miyazaki N, Tochikubo O, Usui T, Kashiwagi M . Diastolic mitral regurgitation in patients with first-degree atrioventricular block. Pacing Clin Electrophysiol. 1992; 15(11 Pt 2):1927-31. DOI: 10.1111/j.1540-8159.1992.tb02996.x. View

13.

PERLMAN L, Ostrander Jr L, Keller J, Chiang B . An epidemiologic study of first degree atrioventricular block in Tecumseh, Michigan. Chest. 1971; 59(1):40-6. DOI: 10.1378/chest.59.1.40. View

14.

Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt O . 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm.... Europace. 2013; 15(8):1070-118. DOI: 10.1093/europace/eut206. View

15.

Fleg J, Das D, Wright J, Lakatta E . Age-associated changes in the components of atrioventricular conduction in apparently healthy volunteers. J Gerontol. 1990; 45(3):M95-100. DOI: 10.1093/geronj/45.3.m95. View

16.

Crisel R, Farzaneh-Far R, Na B, Whooley M . First-degree atrioventricular block is associated with heart failure and death in persons with stable coronary artery disease: data from the Heart and Soul Study. Eur Heart J. 2011; 32(15):1875-80. PMC: 3202329. DOI: 10.1093/eurheartj/ehr139. View

17.

Kim Y, ONunain S, Trouton T, Levine R, Garan H, Ruskin J . Pseudo-pacemaker syndrome following inadvertent fast pathway ablation for atrioventricular nodal reentrant tachycardia. J Cardiovasc Electrophysiol. 1993; 4(2):178-82. DOI: 10.1111/j.1540-8167.1993.tb01221.x. View

18.

Botto G, Iuliano A, Occhetta E, Belotti G, Russo G, Campari M . A randomized controlled trial of cardiac resynchronization therapy in patients with prolonged atrioventricular interval: the REAL-CRT pilot study. Europace. 2019; 22(2):299-305. DOI: 10.1093/europace/euz321. View

19.

Keene D, Arnold A, Shun-Shin M, Howard J, Sohaib S, Moore P . Rationale and design of the randomized multicentre His Optimized Pacing Evaluated for Heart Failure (HOPE-HF) trial. ESC Heart Fail. 2018; 5(5):965-976. PMC: 6165934. DOI: 10.1002/ehf2.12315. View

20.

Chelu M, Gunderson B, Koehler J, Ziegler P, Sears S . Patient Activity Decreases and Mortality Increases After the Onset of Persistent Atrial Fibrillation in Patients With Implantable Cardioverter-Defibrillators. JACC Clin Electrophysiol. 2018; 2(4):518-523. DOI: 10.1016/j.jacep.2016.01.015. View