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Published on: July 20, 2022
First-degree atrioventricular block is associated with advanced atrioventricular block, atrial fibrillation and left
Jae-Sun Uhm1, Jaemin Shim, Jin Wi
1Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Insights
First-degree atrioventricular block (AVB) in hypertensive patients indicates a higher risk for advanced AVB, atrial fibrillation, and left ventricular dysfunction. This finding highlights the clinical significance of monitoring PR intervals in hypertension management.
Area of Science:
- Cardiology
- Electrophysiology
- Hypertension Research
Background:
- First-degree atrioventricular block (AVB) is common in hypertensive individuals.
- The long-term prognostic implications of first-degree AVB in this population remain unclear.
- Understanding these risks is crucial for effective hypertension management and cardiovascular risk stratification.
Purpose of the Study:
- To investigate the long-term prognosis of first-degree AVB in patients with hypertension.
- To determine if first-degree AVB is an independent risk factor for adverse cardiovascular outcomes.
- To compare the incidence of advanced AVB, sick sinus syndrome, atrial fibrillation, and left ventricular dysfunction between hypertensive patients with and without first-degree AVB.
Main Methods:
- A cohort of 3816 hypertensive patients was analyzed.
- Patients were categorized based on PR interval duration: normal (120-200 ms) versus first-degree AVB (>200 ms).
- Electrocardiograms were reviewed, and outcomes including advanced AVB, sick sinus syndrome, atrial fibrillation, and left ventricular dysfunction were tracked over a mean follow-up of 9.4 years.
Main Results:
- First-degree AVB was present in 14.3% of the hypertensive patients.
- Patients with first-degree AVB showed significantly higher cumulative incidence of advanced AVB, atrial fibrillation, and left ventricular dysfunction.
- Multivariate analysis confirmed first-degree AVB as an independent risk factor for advanced AVB (HR 2.77), atrial fibrillation (HR 2.33), and left ventricular dysfunction (HR 1.49). Sick sinus syndrome was not associated.
Conclusions:
- First-degree AVB is a significant independent risk factor in hypertensive patients.
- It predicts the future development of advanced AVB, atrial fibrillation, and left ventricular dysfunction.
- Routine ECG monitoring for PR interval prolongation is recommended for hypertensive patients to identify those at higher cardiovascular risk.
Objectives:
Clinical significance of first-degree atrioventricular block (AVB) have not been known in patients with hypertension. This study was performed to elucidate long-term prognosis of first-degree AVB in patients with hypertension.
Methods:
We included 3816 patients (mean age, 61.0 ± 10.6 years; men, 47.2%) with hypertension. We reviewed their ECGs and measured the PR interval. The patients were divided into two groups: normal PR interval (120 ms ≤ PR ≤200 ms) and first-degree AVB (PR >200 ms). We compared the incidence, cumulative incidence and hazard ratios of advanced AVB, sick sinus syndrome, atrial fibrillation and left ventricular dysfunction between the two groups during the follow-up period.
Results:
The prevalence of first-degree AVB in patients with hypertension was 14.3%. The patients were followed up for 9.4 ± 2.4 years. Incidence and cumulative incidence of advanced AVB, atrial fibrillation and left ventricular dysfunction in patients with first-degree AVB were significantly higher than in patients with normal PR interval. By multivariate Cox's regression, patients with first-degree AVB had an increased risk of advanced AVB [hazard ratio 2.77; 95% confidence interval (95% CI) 1.38-5.59; P = 0.004], atrial fibrillation (hazard ratio 2.33; 95% CI 1.84-2.94; P < 0.001) and left ventricular dysfunction (hazard ratio 1.49; 95% CI 1.11-2.00; P = 0.009). However, sick sinus syndrome was not associated with first-degree AVB.
Conclusion:
First-degree AVB is an independent risk factor for future development of advanced AVB, atrial fibrillation and left ventricular dysfunction in patients with hypertension.
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