Atrioventricular Block and Atrioventricular Dissociation

Schwartzman, David

doi:10.1016/b0-7216-0323-8/50056-7

Cited by 16 publications

(13 citation statements)

References 7 publications

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“…Although prolongation of the PR interval usually involves a conduction delay in the atrioventricular node, it is frequently accompanied by a conduction delay in the atrium as well. 11,12) The total atrial conduction time was recently found to be a very strong predictor of AF. 13,14) The prolonged PR interval probably also refl ects a prolonged atrial conduction time that is likely caused by atrial fi brosis and atrial dilatation, which may be involved in the substrate for AF.…”

Section: Discussionmentioning

confidence: 99%

Prolonged PR Interval and Risk of Recurrence of Atrial Fibrillation After Catheter Ablation

Dong

Sang

et al. 2014

Int. Heart J.

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SummaryIt has been demonstrated that a prolonged PR interval is associated with an increased risk of AF. However, the impact of a prolonged PR interval on recurrence of paroxysmal atrial fi brillation (AF) after catheter ablation is not clear. A total of 112 patients with a prolonged PR interval (PR > 200 ms) (PPR group) and 112 age-and gender-matched control patients (on a 1:1 basis) with a normal PR interval (NPR group) were included in this study. AF recurrence was defi ned as the occurrence of confi rmed atrial tachyarrhythmia lasting more than 30 seconds beyond 3 months after catheter ablation in the absence of any antiarrhythmic treatment. During a mean follow-up period of 10.9 ± 5.5 months (range, 3-18 months), 61 patients (27.2%) developed recurrence of AF. The recurrence rate was higher in the PPR group than in the NPR group (33.9% versus 20.5%, respectively; P = 0.018). Cox regression analysis with adjustment for age, body mass index, valvular heart disease, left atrial diameter, and pulmonary vein isolation identifi ed only a prolonged PR interval as an independent predictor of recurrence of AF (hazard ratio, 1.81; 95% confi dence interval, 1.07-3.05; P = 0.027). Patients with a prolonged PR interval were at an increased risk of AF recurrence after catheter ablation. (Int Heart J 2014; 55: 126-130) Key words: Atrial tachyarrhythmia A trial fi brillation (AF) is a common cardiac arrhythmia in the general population 1) and is associated with increased cardiovascular morbidity and mortality.2,3) A recent post hoc analysis of a Danish multicenter randomized trial (DANPACE trial) showed that a prolonged PR interval is associated with an increased risk of AF in patients with sick sinus syndrome.4) These results are in accordance with the fi ndings of a large community-based cohort study in which a PR interval longer than 200 ms was associated with a doubled risk of later AF compared with a shorter PR interval.5) Catheter ablation has been established as an effective therapy for drug-refractory paroxysmal AF. However, there is still a risk of recurrence after ablation. Previous studies have examined some predictors of AF recurrence. 6,7) However, there is little information available about the impact of a prolonged PR interval on recurrence of AF after catheter ablation. In patients with a prolonged PR interval, most of the pathogenic factors for AF persist after ablation. Therefore, it is reasonable to hypothesize that a prolonged PR interval increases the risk of recurrence of AF. This retrospective study evaluated the impact of a prolonged PR interval on recurrence of AF after catheter ablation. MethodsStudy subjects: We reviewed the records of 1593 consecutive patients with refractory symptomatic paroxysmal AF who had been prospectively entered into our database. All of these patients were referred to Beijing An Zhen Hospital, Capital Medical University for first-time circumferential pulmonary vein (PV) radiofrequency ablation from January 2008 to December 2012. The PR interval was considered to be p...

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Section: Discussionmentioning

confidence: 99%

Prolonged PR Interval and Risk of Recurrence of Atrial Fibrillation After Catheter Ablation

Dong

Sang

et al. 2014

Int. Heart J.

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“…Based on ECG criteria, AV blocks are classified as first, second, or third degree . First‐degree AV block is defined as PR interval prolongation above 200 ms, that is, every atrial impulse is conducted to the ventricle with a constantly prolonged PR interval.…”

Section: Atrioventricular Conduction Blockmentioning

confidence: 99%

Vagomimetic Effects of Fingolimod: Physiology and Clinical Implications

Vanoli

Pentimalli²,

Botto³

2014

CNS Neurosci Ther

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Fingolimod is a sphingosine 1-phosphate (S1P) receptor modulator approved to treat relapsing-remitting multiple sclerosis (MS). Initiation of treatment with fingolimod has been found to produce transient bradycardia and/or slowing of atrioventricular impulse conduction in a small proportion of patients. This effect is thought to be due to the interaction of fingolimod with S1P receptors on the surface membrane of atrial myocytes causing a vagomimetic effect, similar to the action of acetylcholine on muscarinic receptors. As a precaution, patients are under electrocardiogram (ECG) monitoring for 6 h after receiving their first dose. Fingolimod is contraindicated in patients with overt or concealed cardiac diseases. However, the Fingolimod Initiation and caRdiac Safety Trial (FIRST), which was designed specifically to investigate the cardiac profile of fingolimod, did not show an increased risk of clinically relevant cardiac events with fingolimod. This review examines the electrophysiology and pathophysiology of cardiac impulse formation in the context of fingolimod. It concludes that these vagomimetic effects should be considered benign and should not prevent the effective use of fingolimod in the treatment of patients with MS.

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“…In the majority of cases, it is due to delayed conduction in the AV node, although conduction delay in the atrium, the His-Purkinje system or multiple sites may also contribute to the prolonged PR interval. 1 In the presence of coronary artery disease (CAD), prolongation of PR interval is associated with an adverse outcome, 2 but in the absence of structural heart disease or other conduction abnormalities, prolonged PR interval has been traditionally considered a benign phenomenon. This belief has based on older studies conducted mainly among healthy young or middle-aged men, which could not demonstrate additional mortality or morbidity associated with PR prolongation.…”

Section: Introductionmentioning

confidence: 99%

Prognostic significance of prolonged PR interval in the general population

Aro

Anttonen

Kerola

et al. 2013

European Heart Journal

121

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AimsProlonged PR interval, or first degree AV block, has been traditionally regarded as a benign electrocardiographic finding in healthy individuals, until recent studies have suggested that it may be associated with increased mortality and morbidity. The aim of this study was to further elucidate clinical and prognostic importance of prolonged PR interval in a large middleaged population with a long follow-up. Methods and resultsWe evaluated 12-lead electrocardiograms of 10 785 individuals aged 30 -59 years (mean age 44 years, 52% males) recorded between 1966 and 1972, and followed the subjects for 30 + 11 years. Prolonged PR interval was defined as PR .200 ms, with further analysis performed using PR ≥220 ms. Main endpoints were all-cause mortality, cardiovascular mortality, and sudden cardiac death, and other endpoints included hospitalizations due to cardiovascular causes. During the baseline examination, prolonged PR interval .200 ms was present in 2.1% of the subjects, but PR interval normalized to ≤200 ms in 30% of these individuals during the follow-up. No increase in mortality or in hospitalizations due to coronary artery disease, heart failure, atrial fibrillation, or stroke was associated with prolonged PR interval (P ¼ non-significant for all endpoints). These results were not changed after multivariate adjustment or in several subanalyses. ConclusionIn the middle-aged general population, prolonged PR interval normalizes in a substantial proportion of subjects during the time course, and it is not associated with an increased risk of all-cause or cardiovascular mortality.--

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Atrioventricular Block and Atrioventricular Dissociation

Cited by 16 publications

References 7 publications

Prolonged PR Interval and Risk of Recurrence of Atrial Fibrillation After Catheter Ablation

Prolonged PR Interval and Risk of Recurrence of Atrial Fibrillation After Catheter Ablation

Vagomimetic Effects of Fingolimod: Physiology and Clinical Implications

Prognostic significance of prolonged PR interval in the general population

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