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 Aug;32(15):1875-80. doi: 10.1093/eurheartj/ehr139. Epub 2011 May 23.


Aims: First-degree atrioventricular block (AVB) has traditionally been considered a benign electrocardiographic finding in healthy individuals. However, the clinical significance of first-degree AVB has not been evaluated in patients with stable coronary heart disease. We investigated whether first-degree AVB is associated with heart failure (HF) and mortality in a prospective cohort study of outpatients with stable coronary artery disease (CAD).

Methods and results: We measured the P-R interval in 938 patients with stable CAD and classified them into those with (P-R interval ≥ 220 ms) and without (P-R interval <220 ms) first-degree AVB. Hazard ratios (HRs) and 95% confidence intervals were calculated for HF hospitalization and all-cause mortality. During 5 years of follow-up, there were 123 hospitalizations for HF and 285 deaths. Compared with patients who had normal atrioventricular conduction, those with first-degree AVB were at increased risk for HF hospitalization (age-adjusted HR 2.33: 95% CI 1.49-3.65; P= 0.0002), mortality [age-adjusted HR 1.58; 95% CI (1.13-2.20); P = 0.008], cardiovascular (CV) mortality [age-adjusted HR 2.33; 95% CI (1.28-4.22); P= 0.005], and the combined endpoint of HF hospitalization or CV mortality (age-adjusted HR 2.43: 95% CI 1.64-3.61; P ≤ 0.0001). These associations persisted after multivariable adjustment for heart rate, medication use, ischaemic burden, and QRS duration. Adjustment for left ventricular systolic and diastolic function partially attenuated the effect, but first-degree AVB remained associated with the combined endpoint of HF or CV death (HR 1.61, CI 1.02-2.54; P= 0.04).

Conclusion: In a large cohort of patients with stable coronary artery disease, first-degree AVB is associated with HF and death.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Ambulatory Care / statistics & numerical data
  • Atrioventricular Block / complications*
  • Atrioventricular Block / mortality
  • Coronary Artery Disease / complications*
  • Coronary Artery Disease / mortality
  • Echocardiography, Doppler
  • Electrocardiography
  • Exercise Test
  • Female
  • Heart Failure / etiology*
  • Heart Failure / mortality
  • Hospitalization / statistics & numerical data
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • San Francisco / epidemiology