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PR interval prolongation, still a marker of worse outcome in patients treated cardiac resynchronization therapy patients

Session Poster Session 3

Speaker Antonius Martinus Wilhelmus van Stipdonk

Congress : Heart Failure 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Cardiac Resynchronization Therapy
  • Session type : Poster Session
  • FP Number : P1544

Authors : A M W Van Stipdonk (Maastricht,NL), M Dural (Eskisehir,TR), F Salden (Maastricht,NL), IAH Ter Horst (Utrecht,NL), HJGM Crijns (Maastricht,NL), FW Prinzen (Maastricht,NL), M Meine (Utrecht,NL), AH Maass (Groningen,NL), K Vernooy (Maastricht,NL)

A M W Van Stipdonk1 , M Dural2 , F Salden3 , IAH Ter Horst4 , HJGM Crijns1 , FW Prinzen3 , M Meine4 , AH Maass5 , K Vernooy1 , 1Maastricht University Medical Centre (MUMC), Cardiology - Maastricht - Netherlands (The) , 2Eskisehir Osmangazi University, Cardiology - Eskisehir - Turkey , 3Cardiovascular Research Institute Maastricht (CARIM), Physiology - Maastricht - Netherlands (The) , 4University Medical Center Utrecht, Cardiology - Utrecht - Netherlands (The) , 5University Medical Center Groningen, Cardiology - Groningen - Netherlands (The) ,


Background: Patients without left bundle branch block (non-LBBB) generally derive little benefit from CRT. Recently, CRT has been suggested to be beneficial in patients with  prolonged PR interval. However, in the general HF population the presence of a prolonged PR interval is associated with worse outcome.

Purpose: To evaluate the association of a prolonged PR interval with clinical outcome in CRT-treated LBBB and non-LBBB patients.

Methods: Pre-implantation 12-lead ECGs from 1.245 consecutive CRT patients without atrial fibrillation from 3 implanting centres in the Netherlands, were evaluated for the presence of LBBB QRS morphology and PR interval prolongation (=230ms). The primary endpoint was the combination of left ventricular assist device implantation, cardiac transplantation and all-cause mortality.

Results:  Patients with LBBB (n=620) showed a significantly shorter mean PR interval than non-LBBB patients (n=625) (187ms vs 198ms, p<0.001). Prolonged PR interval was found in 12.6% of patients with LBBB and 19.2% of non-LBBB patients (p=0.001). In non-LBBB patients with PR prolongation event rate was significantly higher (54 vs 34%, p<0.001). In LBBB patients there was a non-significant difference (28 vs 20%, p=0.1). Regression analyses (figure 1) showed similar results, with a significantly higher odds of experiencing an event in non-LBBB patients with PR prolongation (2.24 [1.68, 2.99], p<0.001), and a trend to significantly higher odds in LBBB patients with PR prolongation (HR 1.61 [1.02, 2.56], p=0.04).

Conclusion: In HF patients treated with CRT, PR prolongation is negatively associated with long term clinical outcome. This association seems to be stronger in non-LBBB patients than in LBBB patients.

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