Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes: a systematic review and meta-analysis

Mamas; Rashid, Muhammad; Nolan, James

Abstract

Abstract Objective: First-degree atrioventricular block is frequently encountered in clinical practice and is generally considered a benign process. However, there is emerging evidence that prolonged PR interval may be associated with adverse outcomes. This study aims to determine if prolonged PR interval is associated with adverse cardiovascular outcomes and mortality. Methods: We searched MEDLINE and EMBASE for studies that evaluated clinical outcomes associated with prolonged and normal PR intervals. Relevant studies were pooled using random effects meta-analysis for risk of mortality, cardiovascular mortality, heart failure, coronary heart disease, atrial fibrillation and stroke or transient ischemic attack. Sensitivity analyses were performed considering the population type and use of adjustments. Results: Our search yielded 14 studies that were undertaken between 1972 and 2011 with 400,750 participants. Among the studies that adjusted for potential confounders, the pooled results suggest an increased risk of mortality with prolonged PR interval RR 1.24 95%CI 1.02-1.51, 5 studies. Prolonged PR interval was associated with significant risk of heart failure or left ventricular dysfunction (RR 1.39 95%CI 1.18-1.65, 3 studies) and atrial fibrillation (RR 1.45 95%CI 1.23-1.71, 8 studies) but not cardiovascular mortality, coronary heart disease or myocardial infarction or stroke or TIA. Similar observations were recorded when limited to studies of first-degree heart block. Conclusions: Data from observational studies suggests a possible association between prolonged PR interval and significant increases in atrial fibrillation, heart failure and mortality. Future prospective studies are needed to confirm the relationships reported, consider possible mechanisms and define the optimal monitoring strategy for such patients.

Citation

Mamas, Rashid, M., & Nolan, J. (2016). Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes: a systematic review and meta-analysis. Heart, https://doi.org/10.1136/heartjnl-2015-308956

• Acceptance Date: Jan 8, 2016
• Publication Date: Feb 15, 2016
• Journal: Heart
• Print ISSN: 1355-6037
• Publisher: BMJ Publishing Group
• DOI: https://doi.org/10.1136/heartjnl-2015-308956
• Keywords: PR interval, atrial fibrillation, heart failure, mortality, electrocardiography
• Publisher URL: http://dx.doi.org/10.1136/heartjnl-2015-308956