Long-term Outcomes in Individuals With Prolonged PR Interval or First-Degree Atrioventricular Block

被引：428

作者：

Cheng, Susan ^{[1
,2
,4
,5
]}

Keyes, Michelle J. ^{[2
,6
]}

Larson, Martin G. ^{[2
,6
]}

McCabe, Elizabeth L. ^{[1
,2
]}

Newton-Cheh, Christopher ^{[1
,2
,3
,7
]}

Levy, Daniel ^{[2
,8
,9
,10
]}

Benjamin, Emelia J. ^{[2
,9
,10
,11
]}

Vasan, Ramachandran S. ^{[2
,9
,10
]}

Wang, Thomas J. ^{[1
,2
]}

机构：

[1] Harvard Univ, Sch Med, Massachusetts Gen Hosp, Div Cardiol, Boston, MA 02114 USA

[2] Framingham Heart Dis Epidemiol Study, Framingham, MA USA

[3] Harvard Univ, Sch Med, Massachusetts Gen Hosp, Ctr Human Genet Res, Boston, MA 02114 USA

[4] Harvard Univ, Sch Med, Brigham & Womens Hosp, Div Cardiovasc Med,Dept Med, Boston, MA 02114 USA

[5] Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Clin Investigator Training Program, Boston, MA 02114 USA

[6] Boston Univ, Dept Math & Stat, Boston, MA 02215 USA

[7] Broad Inst Harvard & MIT, Program Med & Populat Genet, Cambridge, MA USA

[8] NHLBI, Ctr Populat Studies, Bethesda, MD 20892 USA

[9] Boston Univ, Sch Med, Sect Prevent Med, Boston, MA 02118 USA

[10] Boston Univ, Sch Med, Cardiol Sect, Boston, MA 02118 USA

[11] Boston Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA USA

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2009年 / 301卷 / 24期

基金：

美国国家卫生研究院;

关键词：

CORONARY HEART-DISEASE; ATRIAL-FIBRILLATION; RISK-FACTORS; NATURAL-HISTORY; WAVE DURATION; CONDUCTION; REGURGITATION; POPULATION; PROGNOSIS; FEATURES;

D O I：

10.1001/jama.2009.888

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Context Prolongation of the electrocardiographic PR interval, known as first-degree atrioventricular block when the PR interval exceeds 200 milliseconds, is frequently encountered in clinical practice. Objective To determine the clinical significance of PR prolongation in ambulatory individuals. Design, Setting, and Participants Prospective, community-based cohort including 7575 individuals from the Framingham Heart Study (mean age, 47 years; 54% women) who underwent routine 12-lead electrocardiography. The study cohort underwent prospective follow-up through 2007 from baseline examinations in 1968-1974. Multivariable-adjusted Cox proportional hazards models were used to examine the associations of PR interval with the incidence of arrhythmic events and death. Main Outcome Measures Incident atrial fibrillation (AF), pacemaker implantation, and all-cause mortality. Results During follow-up, 481 participants developed AF, 124 required pacemaker implantation, and 1739 died. At the baseline examination, 124 individuals had PR intervals longer than 200 milliseconds. For those with PR intervals longer than 200 milliseconds compared with those with PR intervals of 200 milliseconds or shorter, incidence rates per 10 000 person-years were 140 (95% confidence interval [CI], 95-208) vs 36 (95% CI, 32-39) for AF, 59 (95% CI, 40-87) vs 6 (95% CI, 5-7) for pacemaker implantation, and 334 (95% CI, 260-428) vs 129 (95% CI, 123-135) for all-cause mortality. Corresponding absolute risk increases were 1.04% (AF), 0.53% (pacemaker implantation), and 2.05% (all-cause mortality) per year. In multivariable analyses, each 20-millisecond increment in PR was associated with an adjusted hazard ratio (HR) of 1.11 (95% CI, 1.02-1.22; P = .02) for AF, 1.22 (95% CI, 1.14-1.30; P < .001) for pacemaker implantation, and 1.08 (95% CI, 1.02-1.13; P = .005) for all-cause mortality. Individuals with first-degree atrioventricular block had a 2-fold adjusted risk of AF (HR, 2.06; 95% CI, 1.36-3.12; P < .001), 3-fold adjusted risk of pacemaker implantation (HR, 2.89; 95% CI, 1.83-4.57; P < .001), and 1.4-fold adjusted risk of all-cause mortality (HR, 1.44, 95% CI, 1.09-1.91; P = .01). Conclusion Prolongation of the PR interval is associated with increased risks of AF, pacemaker implantation, and all-cause mortality. JAMA. 2009; 301(24):2571-2577

引用

页码：2571 / 2577

页数：7

共 37 条

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