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PR Segment: Cardiac Implications

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Abstract

PR interval (measured from the initial P wave to the beginning of the QRS complex) reflects the time needed for an electrical impulse to be transmitted from the sinus node to the ventricles, so it is an integration of informations about different sites of the conduction system of the heart. To find a PR interval out of normal limits is not always a benign condition as previously believed. PR prolongation may not only underlie a major conduction disturbance (as in case 2), but it has also been related to the risk of atrial fibrillation (as in case 1); furthermore it may reflect different electrophysiological abnormalities, including atrial enlargement. A short PR interval instead has been shown to be an AF predictor and is linked to higher incidence of ischemic heart disease (as in case 3).

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References

  1. Dilaveris PE, Farbom P, Batchvarov V, et al. Circadian behavior of P-wave duration, P-wave area, and PR interval in healthy subjects. Ann Noninvasive Electrocardiol. 2001;6(2):92–7.

    Article  CAS  Google Scholar 

  2. Josephson ME. Clinical cardiac electrophysiology. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 93–113.

    Google Scholar 

  3. Kwok CS, Rashid M, Beynon R, et al. Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes: a systematic review and meta-analysis. Heart. 2016;102(9):672–80.

    Article  CAS  Google Scholar 

  4. Cheng M, Lu X, Huang J, et al. Electrocardiographic PR prolongation and atrial fibrillation risk: a meta-analysis of prospective cohort studies. J Cardiovasc Electrophysiol. 2015;26(1):36–41.

    Article  Google Scholar 

  5. Nielsen JB, Pietersen A, Graff C, et al. Risk of atrial fibrillation as a function of the electrocardiographic PR interval: results from the Copenhagen ECG Study. Heart Rhythm. 2013;10(9):1249–56.

    Article  Google Scholar 

  6. Iwasaki Y, Nishida K, Kato T, et al. Atrial fibrillation pathophysiology: implications for management. Circulation. 2011;124(20):2264–74.

    Article  CAS  Google Scholar 

  7. Chan Y, Siu C, Yiu K, et al. Prolongation of PR interval is associated with endothelial dysfunction and activation of vascular repair in high-risk cardiovascular patients. J Interv Card Electrophysiol. 2013;37(1):55–61.

    Article  Google Scholar 

  8. Aro AL, Anttonen O, Kerola T, et al. Prognostic significance of prolonged PR interval in the general population. Eur Heart J. 2014;35(2):123–9.

    Article  Google Scholar 

  9. Perez MV, Dewey FE, Marcus R, et al. Electrocardiographic predictors of atrial fibrillation. Am Heart J. 2009;158(4):622–8.

    Article  Google Scholar 

  10. Okutucu S, Aytemir K, Oto A. P-wave dispersion: what we know till now? JRSM Cardiovasc Dis. 2016;5:1–9.

    Google Scholar 

  11. Holmqvist F, et al. Clinical outcome as a function of the PR-interval- there is virtue in moderation: data from the Duke Databank for cardiovascular disease. Europace. 2015;17:978–85.

    Article  Google Scholar 

  12. Issa ZF, Miller JM, Zipes DP. Clinical arrhythmology and electrophysiology: a companion to Braunwald’s heart disease. 2nd ed. Philadelphia: Saunders Elsevier; 2009.

    Google Scholar 

  13. Waller BF, Gering LE, Branyas NA, et al. Anatomy, histology and pathology of the cardiac conduction system-part V. Clin Cardiol. 1993;16:565–9.

    Article  CAS  Google Scholar 

  14. De Jong S, van Veen TAB, van Rijen HVM, et al. Fibrosis and cardiac arrhythmias. J Cardiovasc Pharmacol. 2011;57:630–8.

    Article  Google Scholar 

  15. Rasmussen PV, et al. Electrocardiographic PR-interval duration and cardiovascular risk: results from the Copenhagen ECG study. Can J Cardiol. 2017;33(5):674–81. https://doi.org/10.1016/j.cjca.2017.02.015.

    Article  PubMed  Google Scholar 

  16. Cheng S, Keyes MJ, et al. Long-term outcomes in individuals with prolonged PR interval or first-degree atrioventricular block. JAMA. 2009;301(24):2571–7.

    Article  CAS  Google Scholar 

  17. Crisel RK, Farzaneh-Far R, Na B, et al. First-degree atrioventricular block is associated with heart failure and death in persons with stable coronary artery disease: data from the Heart and Soul study. Eur Heart J. 2011;32(15):1875–80.

    Article  Google Scholar 

  18. Magnani JW, Wang N, Nelson KP, et al. Electrocardiographic PR interval and adverse outcomes in older adults: the health, aging, and body composition study. Circ Arrhythm Electrophysiol. 2013;6(1):84–90.

    Article  Google Scholar 

  19. Knuiman M, Briffa T, et al. A cohort study examination of established and emerging risk factors for atrial fibrillation: the Busselton Health Study. Eur J Epidemiol. 2014;29(3):181–90.

    Article  Google Scholar 

  20. Kobayashi T, Watanabe M, Kokubo Y, et al. Prolonged PR interval is significantly associated with increased risk of cardiovascular diseases and stroke in a population-based cohort study. Circulation. 2014;130:A13451.

    Google Scholar 

  21. Uhm JS, Shim J, et al. First-degree atrioventricular block is associated with advanced atrioventricular block, atrial fibrillation and left ventricular dysfunction in patients with hypertension. J Hypertens. 2104;32(5):1115–20.

    Article  Google Scholar 

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Authors and Affiliations

  1. Clinica di Cardiologia ed Aritmologia, Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy

    Silvia Cesini, Simone D’Agostino, Francesca Patani & Francesca Troiano

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  1. Silvia Cesini
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  2. Simone D’Agostino
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  3. Francesca Patani
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  4. Francesca Troiano
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Editor information

Editors and Affiliations

  1. Cardiology Clinic, Marche Polytechnic University Cardiology Clinic, Ancona, Italy

    Alessandro Capucci

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Cesini, S., D’Agostino, S., Patani, F., Troiano, F. (2019). PR Segment: Cardiac Implications. In: Capucci, A. (eds) New Concepts in ECG Interpretation. Springer, Cham. https://doi.org/10.1007/978-3-319-91677-4_3

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  • DOI: https://doi.org/10.1007/978-3-319-91677-4_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-91676-7

  • Online ISBN: 978-3-319-91677-4

  • eBook Packages: MedicineMedicine (R0)

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