Skip to main content

Association Between a Prolonged PR Interval and Outcomes of Cardiac Resynchronization Therapy: A Report From the National Cardiovascular Data Registry.

Publication ,  Journal Article
Friedman, DJ; Bao, H; Spatz, ES; Curtis, JP; Daubert, JP; Al-Khatib, SM
Published in: Circulation
November 22, 2016

BACKGROUND: A prolonged PR interval is common among cardiac resynchronization therapy (CRT) candidates; however, the association between PR interval and outcomes is unclear, and the data are conflicting. METHODS: We conducted inverse probability weighted analyses of 26 451 CRT-eligible (ejection fraction ≤35, QRS ≥120 ms) patients from the National Cardiovascular Data Registry ICD Registry to assess the association between a prolonged PR interval (≥230 ms), receipt of CRT with defibrillator (CRT-D) versus implantable cardioverter defibrillator (ICD), and outcomes. We first tested the association between a prolonged PR interval and outcomes among patients stratified by device type. Next, we performed a comparative effectiveness analysis of CRT-D versus ICD among patients when stratified by PR interval. Using Medicare claims data, we followed up with patients up to 5 years for incident heart failure hospitalization or death. RESULTS: Patients with a PR≥230 ms (15%; n=4035) were older and had more comorbidities, including coronary artery disease, atrial arrhythmias, diabetes mellitus, and chronic kidney disease. After risk adjustment, a PR≥230 ms (versus PR<230 ms) was associated with increased risk of heart failure hospitalization or death among CRT-D (hazard ratio, 1.23; 95% confidence interval, 1.14-1.31; P<0.001) but not ICD recipients (hazard ratio, 1.08; 95% confidence interval, 0.97-1.20; P=0.17) (Pinteraction=0.043). CRT-D (versus ICD) was associated with lower rates of heart failure hospitalization or death among patients with PR<230 ms (hazard ratio, 0.79; 95% confidence interval, 0.73-0.85; P<0.001) but not PR≥230 ms (hazard ratio, 1.01; 95% confidence interval, 0.87-1.17; P=0.90) (Pinteraction=0.0025). CONCLUSIONS: A PR≥230 ms is associated with increased rates of heart failure hospitalization or death among CRT-D patients. The real-world comparative effectiveness of CRT-D (versus ICD) is significantly less among patients with a PR≥230 ms in comparison with patients with a PR<230 ms.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

November 22, 2016

Volume

134

Issue

21

Start / End Page

1617 / 1628

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Research Design
  • Registries
  • Male
  • Humans
  • Heart Failure
  • Heart Conduction System
  • Female
  • Cardiovascular System & Hematology
  • Cardiac Resynchronization Therapy
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Friedman, D. J., Bao, H., Spatz, E. S., Curtis, J. P., Daubert, J. P., & Al-Khatib, S. M. (2016). Association Between a Prolonged PR Interval and Outcomes of Cardiac Resynchronization Therapy: A Report From the National Cardiovascular Data Registry. Circulation, 134(21), 1617–1628. https://doi.org/10.1161/CIRCULATIONAHA.116.022913
Friedman, Daniel J., Haikun Bao, Erica S. Spatz, Jeptha P. Curtis, James P. Daubert, and Sana M. Al-Khatib. “Association Between a Prolonged PR Interval and Outcomes of Cardiac Resynchronization Therapy: A Report From the National Cardiovascular Data Registry.Circulation 134, no. 21 (November 22, 2016): 1617–28. https://doi.org/10.1161/CIRCULATIONAHA.116.022913.
Friedman DJ, Bao H, Spatz ES, Curtis JP, Daubert JP, Al-Khatib SM. Association Between a Prolonged PR Interval and Outcomes of Cardiac Resynchronization Therapy: A Report From the National Cardiovascular Data Registry. Circulation. 2016 Nov 22;134(21):1617–28.
Friedman, Daniel J., et al. “Association Between a Prolonged PR Interval and Outcomes of Cardiac Resynchronization Therapy: A Report From the National Cardiovascular Data Registry.Circulation, vol. 134, no. 21, Nov. 2016, pp. 1617–28. Pubmed, doi:10.1161/CIRCULATIONAHA.116.022913.
Friedman DJ, Bao H, Spatz ES, Curtis JP, Daubert JP, Al-Khatib SM. Association Between a Prolonged PR Interval and Outcomes of Cardiac Resynchronization Therapy: A Report From the National Cardiovascular Data Registry. Circulation. 2016 Nov 22;134(21):1617–1628.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

November 22, 2016

Volume

134

Issue

21

Start / End Page

1617 / 1628

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Research Design
  • Registries
  • Male
  • Humans
  • Heart Failure
  • Heart Conduction System
  • Female
  • Cardiovascular System & Hematology
  • Cardiac Resynchronization Therapy