First degree AV block natural history, complications and prognosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{First degree AV block}} | {{First degree AV block}} | ||
{{CMG}}; {{AE}} {{CZ}} | {{CMG}}; {{AE}} {{Sara.Zand}} {{CZ}} | ||
==Overview== | |||
[[First-degree]] [[atrioventricular block]] may be due to conduction delay in the [[atrium]], [[atrioventricular node]], and/or [[His-Purkinje system]]. The [[atrioventricular node]] is the site most commonly involved in [[ adults]]. However, more than 1 site of [[conduction ]] delay is often present. Isolated [[First-degree atrioventricular]] has few [[clinical]] consequences. There are no [[symptoms]] or [[signs ]] associated with it. [[First-degree AV block]] rarely progresses to more severe form of [[conduction abnormalities]]. In the setting of [[neuromuscular]] [[diseases]] such as [[myotonic dystrophy]] 1 with conduction abnormalities in the [[heart]], [[First-degree AV block]] may progress to [[complete heart block]] during variable period of time. Common complications associated with [[first-degree heart block]] may include increased risk of [[atrial fibrillation]], increased risk of [[pacemaker]] implantation. Prognosis of [[First degree AV block]] is generally good. However, some studies showed worse prognosis with [[PR prolongation]]. Presence of [[First degree AV block]] is shown to be associated with a higher risk of [[cardiovascular]] and [[all-cause mortality]] as well as higher risk of [[heart failure]], [[left ventricular]] dysfunction, and [[atrial fibrillation]]. | |||
==Natural History== | ==Natural History== | ||
Isolated first degree | *[[First-degree]] [[atrioventricular block]] may be due to conduction delay in the [[atrium]], [[atrioventricular node]], and/or [[His-Purkinje system]] | ||
* The [[atrioventricular node]] is the site most commonly involved in [[ adults]]. However, more than 1 site of [[conduction ]] delay is often present. | |||
*Isolated first-degree [[atrioventricular]] has few [[clinical]] consequences. There are no [[symptoms]] or [[signs ]] associated with it. | |||
**[[First-degree AV block]] rarely progresses to more severe form of [[conduction abnormalities]], it is mostly a benign [[condition]] in [[healthy]] middle-aged [[men]] and is not correlated with [[coronary heart disease]].<ref name="pmid6705291">{{cite journal| author=Erikssen J, Otterstad JE| title=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. | journal=Clin Cardiol | year= 1984 | volume= 7 | issue= 1 | pages= 6-13 | pmid=6705291 | doi=10.1002/clc.4960070104 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6705291 }}</ref> | |||
* In the setting of [[neuromuscular]] [[diseases]] such as [[myotonic dystrophy]] 1 with conduction abnormalities in the [[heart]], [[First-degree AV block]] may progress to [[complete heart block]] during variable period of time. | |||
In | |||
==Complications== | ==Complications== | ||
Common complications associated with [[first-degree heart block]] may include the following: <ref>{{cite journal | author=Cheng S, Keyes MJ, Larson MG, McCabe EL, Newton-Cheh C, Levy D, Benjamin EJ, Vasan RS, Wang TJ | title=Long-term outcomes in individuals with prolonged PR interval or first-degree atrioventricular block | journal=JAMA | year=2009 | volume=301 | issue=24 | pages=25712577 | doi=10.1001/jama.2009.888}}</ref> | |||
* | * Increased risk of [[atrial fibrillation]] | ||
* Increased risk of [[Pacemaker implantation]] | |||
*:: Individuals who have the [[First-degree block]] as part of a triad of [[First-degree heart block]], [[right bundle branch block]], and either [[left anterior fascicular block]] or [[left posterior fascicular block]] (known as [[trifascicular block]]) may be at an increased risk of progression to [[complete heart block]]. | |||
==Prognosis== | |||
== | * Prognosis of first degree [[AV block]] is generally good<ref name="MyminMathewson1986">{{cite journal|last1=Mymin|first1=David|last2=Mathewson|first2=Francis A.L.|last3=Tate|first3=Robert B.|last4=Manfreda|first4=Jure|title=The Natural History of Primary First-Degree Atrioventricular Heart Block|journal=New England Journal of Medicine|volume=315|issue=19|year=1986|pages=1183–1187|issn=0028-4793|doi=10.1056/NEJM198611063151902}}</ref>. However, some studies showed worse prognosis with [[PR prolongation]].<ref>{{cite journal | author=Cheng S, Keyes MJ, Larson MG, McCabe EL, Newton-Cheh C, Levy D, Benjamin EJ, Vasan RS, Wang TJ | title=Long-term outcomes in individuals with prolonged PR interval or first-degree atrioventricular block | journal=JAMA | year=2009 | volume=301 | issue=24 | pages=25712577 | doi=10.1001/jama.2009.888}}</ref> | ||
* Presence of first degree [[AV block]] is shown to be associated with a higher risk of [[cardiovascular]] and all-cause mortality.<ref>{{cite journal|doi=10.1016/j.hrthm.2010.09.020.Epub2010Sep22}}</ref> | |||
* In a 2016 meta-analysis, first degree [[AV block]] was found to be associated with higher [[mortality]] risk. It was also associated with a high risk of [[heart failure]], [[left ventricular]] dysfunction, and [[atrial fibrillation]]. However, it was not associated with high risk of [[coronary artery disease]], [[stroke]], or [[myocardial infarction]].<ref name="pmid26879241">{{cite journal| author=Kwok CS, Rashid M, Beynon R, Barker D, Patwala A, Morley-Davies A et al.| title=Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes: a systematic review and meta-analysis. | journal=Heart | year= 2016 | volume= 102 | issue= 9 | pages= 672-80 | pmid=26879241 | doi=10.1136/heartjnl-2015-308956 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26879241 }}</ref> | |||
* In a 2016 meta-analysis, first degree AV block was found to be associated with | |||
==References== | ==References== | ||
Latest revision as of 05:48, 22 July 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3]
Overview
First-degree atrioventricular block may be due to conduction delay in the atrium, atrioventricular node, and/or His-Purkinje system. The atrioventricular node is the site most commonly involved in adults. However, more than 1 site of conduction delay is often present. Isolated First-degree atrioventricular has few clinical consequences. There are no symptoms or signs associated with it. First-degree AV block rarely progresses to more severe form of conduction abnormalities. In the setting of neuromuscular diseases such as myotonic dystrophy 1 with conduction abnormalities in the heart, First-degree AV block may progress to complete heart block during variable period of time. Common complications associated with first-degree heart block may include increased risk of atrial fibrillation, increased risk of pacemaker implantation. Prognosis of First degree AV block is generally good. However, some studies showed worse prognosis with PR prolongation. Presence of First degree AV block is shown to be associated with a higher risk of cardiovascular and all-cause mortality as well as higher risk of heart failure, left ventricular dysfunction, and atrial fibrillation.
Natural History
- First-degree atrioventricular block may be due to conduction delay in the atrium, atrioventricular node, and/or His-Purkinje system
- The atrioventricular node is the site most commonly involved in adults. However, more than 1 site of conduction delay is often present.
- Isolated first-degree atrioventricular has few clinical consequences. There are no symptoms or signs associated with it.
- First-degree AV block rarely progresses to more severe form of conduction abnormalities, it is mostly a benign condition in healthy middle-aged men and is not correlated with coronary heart disease.[1]
- In the setting of neuromuscular diseases such as myotonic dystrophy 1 with conduction abnormalities in the heart, First-degree AV block may progress to complete heart block during variable period of time.
Complications
Common complications associated with first-degree heart block may include the following: [2]
- Increased risk of atrial fibrillation
- Increased risk of Pacemaker implantation
- Individuals who have the First-degree block as part of a triad of First-degree heart block, right bundle branch block, and either left anterior fascicular block or left posterior fascicular block (known as trifascicular block) may be at an increased risk of progression to complete heart block.
Prognosis
- Prognosis of first degree AV block is generally good[3]. However, some studies showed worse prognosis with PR prolongation.[4]
- Presence of first degree AV block is shown to be associated with a higher risk of cardiovascular and all-cause mortality.[5]
- In a 2016 meta-analysis, first degree AV block was found to be associated with higher mortality risk. It was also associated with a high risk of heart failure, left ventricular dysfunction, and atrial fibrillation. However, it was not associated with high risk of coronary artery disease, stroke, or myocardial infarction.[6]
References
- ↑ Erikssen J, Otterstad JE (1984). "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. 7 (1): 6–13. doi:10.1002/clc.4960070104. PMID 6705291.
- ↑ Cheng S, Keyes MJ, Larson MG, McCabe EL, Newton-Cheh C, Levy D, Benjamin EJ, Vasan RS, Wang TJ (2009). "Long-term outcomes in individuals with prolonged PR interval or first-degree atrioventricular block". JAMA. 301 (24): 25712577. doi:10.1001/jama.2009.888.
- ↑ Mymin, David; Mathewson, Francis A.L.; Tate, Robert B.; Manfreda, Jure (1986). "The Natural History of Primary First-Degree Atrioventricular Heart Block". New England Journal of Medicine. 315 (19): 1183–1187. doi:10.1056/NEJM198611063151902. ISSN 0028-4793.
- ↑ Cheng S, Keyes MJ, Larson MG, McCabe EL, Newton-Cheh C, Levy D, Benjamin EJ, Vasan RS, Wang TJ (2009). "Long-term outcomes in individuals with prolonged PR interval or first-degree atrioventricular block". JAMA. 301 (24): 25712577. doi:10.1001/jama.2009.888.
- ↑ . doi:10.1016/j.hrthm.2010.09.020.Epub2010Sep22. Missing or empty
|title=(help) - ↑ Kwok CS, Rashid M, Beynon R, Barker D, Patwala A, Morley-Davies A; et al. (2016). "Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes: a systematic review and meta-analysis". Heart. 102 (9): 672–80. doi:10.1136/heartjnl-2015-308956. PMID 26879241.