First-degree atrioventricular block is significantly associated with incident atrial fibrillation in the population predominantly including participants aged ≥ 60 years


Some previous studies demonstrated that first-degree atrioventricular block (f-AVB) was associated with incident atrial fibrillation (AF), while evidence is scarce regarding the association between f-AVB and incident AF in older populations. Therefore, we sought to investigate the association of f-AVB with incident AF in the population predominantly including participants aged ≥ 60 years. Eligible participants were residents in Kanazawa City, Japan aged ≥ 40 years who underwent 12-lead ECG at the National Japanese Health Check-up in 2013. Participants with AF detected at the baseline exam and those without adequate follow-up were excluded. f-AVB was defined as PR interval ≥ 220 ms based on the Minnesota code (6-3). The cumulative incidence of AF was estimated by the Kaplan–Meier curve analysis, and statistical significance was evaluated by the Log-rank test. Unadjusted and adjusted hazard ratios (HRs) were computed by Cox proportional hazard models. HRs were adjusted for conventional risk factors for AF. 37,730 participants (mean age, 72.3 ± 9.6 years; male, 37%) were included. Baseline f-AVB was observed in 667 (1.8%) participants. During the median follow-up period of 5 years (interquartile range, 4.0–5.0 years), 691 cases of incident AF were observed. A 5-year cumulative incidence of AF was significantly higher in f-AVB (+) group compared with f-AVB (−) group (6.8% vs 2.1%, p < 0.01). In the fully adjusted model, f-AVB was significantly associated with incident AF (HR, 1.75; 95% confidence interval 1.25–2.45; p value < 0.01). f-AVB was independently associated with incident AF in the population predominantly including participants aged ≥ 60 years.

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  1. 1.

    Tanaka Y, Bundy JD, Allen NB, Uddin SMI, Feldman DI, Michos ED, Heckbert SR, Greenland P (2020) Association of erectile dysfunction with incident atrial fibrillation: the multi-ethnic study of atherosclerosis (MESA). Am J Med 133:613-620.e1

    CAS  Article  Google Scholar 

  2. 2.

    Jurin I, Lucijanic M, Jurin H, Starcevic B, Varvodic J, Catic J, Jurisic A, Vitlov P, Tomic SS, Lucijanic J, Hadzibegovic I (2020) Patients with atrial fibrillation and mid-range ejection fraction differ in anticoagulation pattern, thrombotic and mortality risk independently of CHA. Heart Vessels 35:1243–1249

    Article  Google Scholar 

  3. 3.

    Perlman LV, Ostrander LD, Keller JB, Chiang BN (1971) An epidemiologic study of first degree atrioventricular block in Tecumseh, Michigan. Chest 59:40–46

    CAS  Article  Google Scholar 

  4. 4.

    Aro AL, Anttonen O, Kerola T, Junttila MJ, Tikkanen JT, Rissanen HA, Reunanen A, Huikuri HV (2014) Prognostic significance of prolonged PR interval in the general population. Eur Heart J 35:123–129

    Article  Google Scholar 

  5. 5.

    Mymin D, Mathewson FA, Tate RB, Manfreda J (1986) The natural history of primary first-degree atrioventricular heart block. N Engl J Med 315:1183–1187

    CAS  Article  Google Scholar 

  6. 6.

    Hisamatsu T, Miura K, Fujiyoshi A, Okamura T, Ohkubo T, Nagasawa S, Horie M, Okayama A, Ueshima H, NIPPON DATA80 Research Group (2015) Long-term outcomes associated with prolonged PR interval in the general Japanese population. Int J Cardiol 184:291–293

    Article  Google Scholar 

  7. 7.

    Cheng S, Keyes MJ, Larson MG, McCabe EL, Newton-Cheh C, Levy D, Benjamin EJ, Vasan RS, Wang TJ (2009) Long-term outcomes in individuals with prolonged PR interval or first-degree atrioventricular block. JAMA 301:2571–2577

    CAS  Article  Google Scholar 

  8. 8.

    Droppa M, Rudolph TK, Baan J, Nielsen NE, Baumgartner H, Vendrik J, Froehlich M, Borst O, Wöhrle J, Gawaz M, Potratz P, Hack LP, Mauri V, Baranowski J, Bramlage P, Kurucova J, Thoenes M, Rottbauer W, Geisler T (2020) Risk factors for permanent pacemaker implantation in patients receiving a balloon-expandable transcatheter aortic valve prosthesis. Heart Vessels 35:1735–1745

    Article  Google Scholar 

  9. 9.

    Kwok CS, Rashid M, Beynon R, Barker D, Patwala A, Morley-Davies A, Satchithananda D, Nolan J, Kyint P, Buchan I, Loke YK, Mamas MA (2016) Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes: systematic review and meta-analysis. Heart 102:672–680

    CAS  Article  Google Scholar 

  10. 10.

    Tada H, Kawashiri MA, Sakata K, Yoneda T, Yasuda K, Yamagishi M, Hayashi K (2017) Renal glucosuria is not associated with atherosclerotic cardiovascular disease outcome in a general Japanese community. Atherosclerosis 261:111–116

    CAS  Article  Google Scholar 

  11. 11.

    Kohro T, Furui Y, Mitsutake N, Fujii R, Morita H, Oku S, Ohe K, Nagai R (2008) the Japanese national health screening and intervention program aimed at preventing worsening of the metabolic syndrome. Int Heart J 49:193–203

    Article  Google Scholar 

  12. 12.

    Tanaka Y, Tada H, Hara S, Hayashi K, Patel RB, Nishikawa T, Hashiba A, Takamura M, Greenland P, Kawashiri MA (2020) Association of proteinuria with incident atrial fibrillation in the general Japanese population. J Cardiol 77:100–105

    Article  Google Scholar 

  13. 13.

    Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A, Collaborators developing the Japanese equation for estimated GFR (2009) Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 53:982–992

    CAS  Article  Google Scholar 

  14. 14.

    Tsuruya K, Yoshida H, Nagata M, Kitazono T, Hirakata H, Iseki K, Moriyama T, Yamagata K, Yoshida H, Fujimoto S, Asahi K, Kurahashi I, Ohashi Y, Watanabe T (2014) Association of the triglycerides to high-density lipoprotein cholesterol ratio with the risk of chronic kidney disease: analysis in a large Japanese population. Atherosclerosis 233:260–267

    CAS  Article  Google Scholar 

  15. 15.

    Haneda M, Noda M, Origasa H (2018) Japanese clinical practice guideline for diabetes 2016. Diabetol Int 9:1–45

    Article  Google Scholar 

  16. 16.

    Uhm JS, Shim J, Wi J, Mun HS, Park J, Park SH, Joung B, Pak HN, Lee MH (2014) First-degree atrioventricular block is associated with advanced atrioventricular block, atrial fibrillation and left ventricular dysfunction in patients with hypertension. J Hypertens 32:1115–1120 (discussion 1120)

    CAS  Article  Google Scholar 

  17. 17.

    Khurshid S, Choi SH, Weng LC, Wang EY, Trinquart L, Benjamin EJ, Ellinor PT, Lubitz SA (2018) Frequency of cardiac rhythm abnormalities in a half million adults. Circ Arrhythm Electrophysiol 11:e006273

    Article  Google Scholar 

  18. 18.

    Sornsin S (1987) First degree atrioventricular block. J Emerg Med 5:29–34

    CAS  Article  Google Scholar 

  19. 19.

    Alonso A, Krijthe BP, Aspelund T, Stepas KA, Pencina MJ, Moser CB, Sinner MF, Sotoodehnia N, Fontes JD, Janssens AC, Kronmal RA, Magnani JW, Witteman JC, Chamberlain AM, Lubitz SA, Schnabel RB, Agarwal SK, McManus DD, Ellinor PT, Larson MG, Burke GL, Launer LJ, Hofman A, Levy D, Gottdiener JS, Kääb S, Couper D, Harris TB, Soliman EZ, Stricker BH, Gudnason V, Heckbert SR, Benjamin EJ (2013) Simple risk model predicts incidence of atrial fibrillation in a racially and geographically diverse population: the CHARGE-AF consortium. J Am Heart Assoc 2:e000102

    Article  Google Scholar 

  20. 20.

    Kokubo Y, Watanabe M, Higashiyama A, Nakao YM, Kusano K, Miyamoto Y (2017) Development of a basic risk score for incident atrial fibrillation in a Japanese general population- the Suita study. Circ J 81:1580–1588

    Article  Google Scholar 

  21. 21.

    Seaman SR, White IR (2013) Review of inverse probability weighting for dealing with missing data. Stat Methods Med Res 22:278–295

    Article  Google Scholar 

  22. 22.

    Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, Lamas GA, Investigators MST (2003) Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 107:2932–2937

    Article  Google Scholar 

  23. 23.

    Barold SS, Ilercil A, Leonelli F, Herweg B (2006) First-degree atrioventricular block. Clinical manifestations, indications for pacing, pacemaker management & consequences during cardiac resynchronization. J Interv Card Electrophysiol 17:139–152

    Article  Google Scholar 

  24. 24.

    Schnittger I, Appleton CP, Hatle LK, Popp RL (1988) Diastolic mitral and tricuspid regurgitation by Doppler echocardiography in patients with atrioventricular block: new insight into the mechanism of atrioventricular valve closure. J Am Coll Cardiol 11:83–88

    CAS  Article  Google Scholar 

  25. 25.

    Zoob M, Smith KS (1963) The aetiology of complete heart block. Br Med J 2:1149–1153

    CAS  Article  Google Scholar 

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YT was supported by American Heart Association Strategically Focused Research Network (SFRN), 18SFRN34110170.


American Heart Association award as above.

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Tanaka, Y., Tada, H., Hamaya, R. et al. First-degree atrioventricular block is significantly associated with incident atrial fibrillation in the population predominantly including participants aged ≥ 60 years. Heart Vessels (2021).

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  • Atrioventricular block
  • Incident atrial fibrillation