The Impact of the PR Interval in Patients Receiving Cardiac Resynchronization Therapy

Senfield, Jeffrey; Daubert, Claude; Abraham, William T.; Ghio, Stefano; Sutton, Martin St. John; Cerkvenik, Jeffrey; Linde, Cecilia; Gold, Michael R.

doi:10.1016/j.jacep.2017.01.017

Cited by 3 publications

(4 citation statements)

References 32 publications

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“…In contrast to the results of the MADIT-CRT subanalysis, a subanalysis of the REVERSE-trial showed no significant association of PR prolongation to benefit from CRT at all. That study, however, used a cut off for PR interval prolongation of 180 ms (median of population); possibly, this lower cut off may contribute to the absence of any effect as PR prolongation substantially less than 230 ms may not result in the proposed negative haemodynamic consequenses [9]. Also, in a retrospective CRT study involving 291 LBBB patients, it was found that patients with PR interval > 200 ms had less reduction in QRS duration and QRS area and shorter survival free of heart transplantation or LV assist device implantation [25].…”

Section: Pr Prolongation In Non-lbbbmentioning

confidence: 99%

“…Subanalyses of landmark trials suggest significant differences in outcome to CRT in non-LBBB patients with a right bundle branch block (RBBB) conduction pattern, as compared with those with a non-specific interventricular conduction delay (IVCD) [1,2]. Also PR interval prolongation over 230 ms has been associated with increased benefit from CRT [8,9]. Furthermore, retrospective cohort studies have identified left ventricular activation time (LVAT), fragmented QRS (fQRS), and vectorcardiographic QRS area as alternative methods in the evaluation of electrical dyssynchrony in patients with HF and predictors of response to CRT [10][11][12][13].…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

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Association of ECG characteristics with clinical and echocardiographic outcome to CRT in a non-LBBB patient population

Dural

Stipdonk

Salden

et al. 2020

J Interv Card Electrophysiol

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Section: Pr Prolongation In Non-lbbbmentioning

confidence: 99%

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

Association of ECG characteristics with clinical and echocardiographic outcome to CRT in a non-LBBB patient population

Dural

Stipdonk

Salden

et al. 2020

J Interv Card Electrophysiol

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show abstract

“…The majority of other subgroup analyses of biventricular pacing RCTs suggest greater risk when a prolonged PR interval is left untreated (control group); however, this is not universally the case (for example, the REVERSE trial). 16 Furthermore, the majority of subgroup analyses have suggested greater benefit when potentially pathological PR prolongation is shortened by biventricular pacing, but this finding is not always the case. 16 …”

Section: Pr Prolongation: a Potential Therapeutic Target In Heart Fai...mentioning

confidence: 99%

“… 16 Furthermore, the majority of subgroup analyses have suggested greater benefit when potentially pathological PR prolongation is shortened by biventricular pacing, but this finding is not always the case. 16 …”

Section: Pr Prolongation: a Potential Therapeutic Target In Heart Fai...mentioning

confidence: 99%

Frontiers in conduction system pacing: treatment of long PR in patients with heart failure

Kaza,

Keene,

Vijayaraman

et al. 2023

European Heart Journal Supplements

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Patients with heart failure who have a prolonged PR interval are at a greater risk of adverse clinical outcomes than those with a normal PR interval. Potential mechanisms of harm relating to prolonged PR intervals include reduced ventricular filling and also the potential progression to a higher degree heart block. There has, however, been relatively little work specifically focusing on isolated PR prolongation as a therapeutic target. Secondary analyses of trials of biventricular pacing in heart failure have suggested that PR prolongation is both a prognostic marker and a promising treatment target. However, while biventricular pacing offers an improved activation pattern, it is nonetheless less physiological than native conduction in patients with a narrow QRS duration, and thus, may not be the ideal option for achieving therapeutic shortening of atrioventricular delay. Conduction system pacing aims to preserve physiological ventricular activation and may therefore be the ideal method for ventricular pacing in patients with isolated PR prolongation. Acute haemodynamic experiments and the recently reported His-optimized pacing evaluated for heart failure (HOPE HF) Randomised Controlled Trial demonstrates the potential benefits of physiological ventricular pacing on patient symptoms and left ventricular function in patients with heart failure.

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The prognostic predictive value of the components of the PR interval in hospitalized patients with heart failure

Huang

Zhao

et al. 2023

BMC Cardiovasc Disord

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Objective Previous reports on the epidemiology, influencing factors, and the prognostic value of the components of PR interval in hospitalized heart failure patients were limited. Methods This study retrospectively enrolled 1182 patients hospitalized with heart failure from 2014 to 2017. Multiple linear regression analysis was used to explore the association between the components of PR interval and the baseline parameters. The primary outcome was all-cause death or heart transplantation. Multivariable-adjusted Cox proportional hazard regression models were constructed to explore the predictive value of the components of PR interval for the primary outcome. Results In multiple linear regression analysis, higher height (for every 10 cm increase in height: regression coefficient 4.83, P < 0.001) as well as larger atrial and ventricular size were associated with larger P wave duration but not with PR segment. The primary outcome occurred in 310 patients after an average follow-up of 2.39 years. Cox regression analyses revealed that the increase in PR segment was an independent predictor of the primary outcome (every 10 ms increase: hazard ratio 1.041, 95% confidence interval [CI] 1.010–1.083, P = 0.023), whereas the P wave duration did not show significant correlation. When adding the PR segment to an initial prognostic prediction model, the likelihood ratio test and categorical net reclassification index (NRI) showed a significant improvement, but the increase in C-index was not significant. In subgroup analysis, increased PR segment was an independent predictor of the primary endpoint in patients taller than 170 cm (each 10 ms increase: hazard ratio 1.153, 95% CI 1.085–1.225, P < 0.001) but not the shorter group (P for interaction = 0.006). Conclusions In hospitalized patients with heart failure, longer PR segment was an independent predictor of the composite endpoint of all-cause death and heart transplantation, especially in the taller group, but it had limited significance in improving the prognostic risk stratification of this population.

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The Impact of the PR Interval in Patients Receiving Cardiac Resynchronization Therapy

Abstract: Baseline PR interval does not affect clinical outcomes or reverse remodeling with CRT in mild HF. (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction [REVERSE]; NCT00271154).

Cited by 3 publications

References 32 publications

Association of ECG characteristics with clinical and echocardiographic outcome to CRT in a non-LBBB patient population

Association of ECG characteristics with clinical and echocardiographic outcome to CRT in a non-LBBB patient population

Frontiers in conduction system pacing: treatment of long PR in patients with heart failure

The prognostic predictive value of the components of the PR interval in hospitalized patients with heart failure

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