ArticlePacing and clinical electrophysiology : PACE2019
PR Prolongation predicts inadequate resynchronization with biventricular pacing in left bundle branch block.
Article in Pacing and clinical electrophysiology : PACE, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 10 citations in OpenAlex.
- Predictors of patient-perceived functional improvement after cardiac resynchronization therapy: a real-world multi-dimensional analysis of clinical, imaging, and ECG predictors.Frontiers in cardiovascular medicine · 2026Article
- Useful Electrocardiographic Signs to Support the Prediction of Favorable Response to Cardiac Resynchronization Therapy.Journal of cardiovascular development and disease · 2023Review
- Echocardiographic Evaluation of His Bundle Pacing in Patients with Prolonged PR Intervals.Cardiology and cardiovascular medicine · 2023Article
- Epidemiology and Outcomes Associated with PR Prolongation.Cardiac electrophysiology clinics · 2021Review
- Association of ECG characteristics with clinical and echocardiographic outcome to CRT in a non-LBBB patient population.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2021Article
- Concomitant changes in ventricular depolarization and repolarization and long-term outcomes of biventricular pacing.Pacing and clinical electrophysiology : PACE · 2020Observational
Corrections and comments
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Authors and funding
10 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundPR interval prolongation is associated with poor outcome after cardiac resynchronization therapy (CRT) among patients with left bundle branch block (LBBB) but the mechanisms are unknown. We investigated clinical outcomes, electrocardiogram (ECG), and echocardiogram changes after CRT by PR interval.
methodsThis is a retrospective study of CRT recipients with a baseline ejection fraction ≤35% and ECG showing sinus rhythm and LBBB. Patients were stratified by baseline PR interval quartile and the primary combined endpoint was time to heart transplantation, left ventricular assist device (LVAD) implantation, or death. ECG, echocardiogram, and clinical variables were compared to identify mechanisms for observed differences in outcomes.
resultsOf 291 eligible patients, the mean age was 65 years, 60% were male, and 19% had prior atrial fibrillation. Patients with PR prolongation (quartile 4, PR > 200 ms) more frequently had a history of atrial fibrillation, coronary artery bypass graft surgery, prior implantable cardioverter defibrillator implantation, and use of amiodarone than patients in PR quartiles 1-3. A PR > 200ms was associated with an adjusted hazard ratio of 1.7 (95% CI: 1.1-2.5) for the primary endpoint. Patients with PR > 200 ms had less reduction in QRS duration and QRS area after CRT while having more increase in QT and QTc intervals than patients with PR ≤ 200 ms. No major differences were observed in echocardiography by baseline PR interval quartiles.
conclusionsPR prolongation predicts shorter survival free of heart transplantation or LVAD implantation in patients with LBBB. This may be due to inadequate ventricular resynchronization.
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