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Outcomes Related to First-Degree Atrioventricular Block and Therapeutic Implications in Patients With Heart Failure

Theodora Nikolaidou1, Justin M Ghosh1, Andrew L Clark1

  • 1Department of Academic Cardiology, Hull York Medical School, University of Hull, Hull, United Kingdom.

JACC. Clinical Electrophysiology
|May 17, 2018
PubMed

Insights

First-degree atrioventricular block increases risks for atrial fibrillation and worse outcomes with cardiac pacing. Optimizing atrioventricular delay in heart failure patients with this block is crucial but remains unstudied.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • First-degree atrioventricular block (AVB) affects ~4% of the general population and is linked to increased atrial fibrillation risk.
  • In heart failure patients, first-degree AVB prevalence ranges from 15% to 51%.
  • Cardiac pacing in patients with first-degree AVB is associated with poorer outcomes than in those with normal conduction.

Purpose of the Study:

  • To review the impact of first-degree AVB on cardiac resynchronization therapy (CRT) outcomes.
  • To highlight the association between first-degree AVB and increased mortality and heart failure hospitalizations in CRT patients.
  • To emphasize the need for research into optimal atrioventricular (AV) delay optimization in CRT for patients with first-degree AVB.

Main Methods:

  • Literature review of studies investigating first-degree AVB in the context of heart failure and cardiac pacing.
  • Analysis of data from cardiac resynchronization therapy trials.
  • Synthesis of current understanding regarding AV delay optimization in CRT.

Main Results:

  • First-degree AVB is linked to worse outcomes in patients undergoing cardiac pacing.
  • In CRT studies, first-degree AVB correlates with heightened risks of mortality and heart failure hospitalization.
  • Current evidence suggests AV delay optimization is vital in CRT, but optimal methods are undetermined.

Conclusions:

  • First-degree AVB significantly impacts outcomes in heart failure patients, particularly those receiving CRT.
  • Further research is essential to determine the best strategies for AV delay optimization in CRT to improve patient management.
  • Understanding first-degree AVB's role is key to advancing medical and device therapies for heart failure.

Keywords:
cardiac resynchronization therapyfirst-degree atrioventricular blockfirst-degree heart blockheart failure

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