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Aims: First-degree AV block, though considered benign, has been reported to be associated with an increased risk for atrial fibrillation, permanent pacing, heart failure and all-cause mortality. It is possible that the extent of PR prolongation indicates the severity of adverse outcome. This study investigated whether the length of PR and its change with heart rate can predict the need for permanent pacing. Method: We retrospectively studied 21 patients with a PR over 270 ms. Nine patients underwent permanent pacing for symptomatic bradycardia or complete AV block and 12 did not. Two or more PR intervals and corresponding heart rates were measured. The unit change in PR to heart rate was calculated and defined as PR Index. We compared the two groups by Student T test or Fisher Chi Square test. Result: Age, sex distribution and baseline heart rate were similar in the two groups. The baseline mean PR interval was 70 ms greater (though did not reach statistical significance), a PR interval over 350 ms was more common (7/9 vs. 3/12), the mean corrected PR interval by heart rate was significantly longer and the PR index was significantly higher in patients who were paced than in those who were not (all p < 0.05). Conclusion: A very long PR interval may lead to AV dissociation requiring permanent pacing. A PR interval over 350 ms and an exaggerated prolongation of PR per given decrease in heart rate may indicate a high risk of AV dissociation, hence the need for permanent pacing.

Progressive First Degree AV Block Indicates the Need for Permanent Pacing