First degree AV block natural history, complications and prognosis: Difference between revisions
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* Prognosis of first degree AV block is controversial. Some studies showed the first degree AV block associated with good prognosis and others showed worse prognosis with advanced 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> | * Prognosis of first degree AV block is controversial. Some studies showed the first degree AV block associated with good prognosis and others showed worse prognosis with advanced 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 in healthy people and in patients with [[coronary heart disease]] is shown to be associated with higher risk of [[morbidity]] and [[mortality]]. | * Presence of first degree AV block in healthy people and in patients with [[coronary heart disease]] is shown to be associated with higher risk of [[morbidity]] and [[mortality]].<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 a 2016 meta-analysis, first degree AV block was found to be associated with a 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 a 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> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Natural History
Isolated first degree heart block has few if any clinical consequences. There are no symptoms or signs associated with it, and there is little danger of progression to complete heart block.
Complications
Complications of first degree heart block include the following:
- Progression to higher grade heart block
- Reduced cardiac output in left ventricular dysfunction causing syncope and exercise intolerance
- Pacemaker syndrome
Individuals who have 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 controversial. Some studies showed the first degree AV block associated with good prognosis and others showed worse prognosis with advanced PR prolongation.[1]
- Presence of first degree AV block in healthy people and in patients with coronary heart disease is shown to be associated with higher risk of morbidity and mortality.[2]
- In a 2016 meta-analysis, first degree AV block was found to be associated with a 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.[3]
References
- ↑ 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.
- ↑ 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.
- ↑ 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.