Association Between a Prolonged PR Interval and Outcomes of Cardiac Resynchronization Therapy: A Report From the National Cardiovascular Data Registry. Issue 21 (22nd November 2016)

• Record Type: Journal Article
• Authors: Friedman, Daniel J.; Bao, Haikun; Spatz, Erica S.; Curtis, Jeptha P.; Daubert, James P.; Al-Khatib, Sana M.
• Is Part Of: Circulation. Volume 134:Issue 21(2016)
• Publication Date: 2016-11-22
• Subjects: atrioventricular block -- cardiac resynchronization therapy -- cardiomyopathies -- defibrillators -- pacemaker, artificial; Blood -- Circulation -- Periodicals; Cardiovascular system -- Periodicals; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Blood Circulation; Cardiovascular System; Vascular Diseases; 616.1
• DOI: 10.1161/CIRCULATIONAHA.116.022913
• Languages: English
• ISSNs: 0009-7322

Abstract

Abstract : 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) ( P interaction =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) ( P interaction =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. Abstract : Supplemental Digital Content is available in the text.