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Multicenter Study
. 2011 Aug;32(15):1875-80.
doi: 10.1093/eurheartj/ehr139. Epub 2011 May 23.

First-degree atrioventricular block is associated with heart failure and death in persons with stable coronary artery disease: data from the Heart and Soul Study

Ryan K Crisel  1 , Ramin Farzaneh-Far, Beeya Na, Mary A Whooley
Affiliations
Multicenter Study

First-degree atrioventricular block is associated with heart failure and death in persons with stable coronary artery disease: data from the Heart and Soul Study

Ryan K Crisel et al. Eur Heart J. 2011 Aug.

Abstract

Aims: First-degree atrioventricular block (AVB) has traditionally been considered a benign electrocardiographic finding in healthy individuals. However, the clinical significance of first-degree AVB has not been evaluated in patients with stable coronary heart disease. We investigated whether first-degree AVB is associated with heart failure (HF) and mortality in a prospective cohort study of outpatients with stable coronary artery disease (CAD).

Methods and results: We measured the P-R interval in 938 patients with stable CAD and classified them into those with (P-R interval ≥ 220 ms) and without (P-R interval <220 ms) first-degree AVB. Hazard ratios (HRs) and 95% confidence intervals were calculated for HF hospitalization and all-cause mortality. During 5 years of follow-up, there were 123 hospitalizations for HF and 285 deaths. Compared with patients who had normal atrioventricular conduction, those with first-degree AVB were at increased risk for HF hospitalization (age-adjusted HR 2.33: 95% CI 1.49-3.65; P= 0.0002), mortality [age-adjusted HR 1.58; 95% CI (1.13-2.20); P = 0.008], cardiovascular (CV) mortality [age-adjusted HR 2.33; 95% CI (1.28-4.22); P= 0.005], and the combined endpoint of HF hospitalization or CV mortality (age-adjusted HR 2.43: 95% CI 1.64-3.61; P ≤ 0.0001). These associations persisted after multivariable adjustment for heart rate, medication use, ischaemic burden, and QRS duration. Adjustment for left ventricular systolic and diastolic function partially attenuated the effect, but first-degree AVB remained associated with the combined endpoint of HF or CV death (HR 1.61, CI 1.02-2.54; P= 0.04).

Conclusion: In a large cohort of patients with stable coronary artery disease, first-degree AVB is associated with HF and death.

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Figures

Figure 1
Figure 1
Kaplan–Meier curve for the combined endpoint of freedom from heart failure hospitalization or cardiovascular mortality by the presence or absence of first-degree AVB.
Figure 2
Figure 2
Age-adjusted survivor function for the combined endpoint of freedom from heart failure hospitalization or CV mortality by the presence or absence of first-degree AVB.
See this image and copyright information in PMC

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