Heart Rate-Adjusted PR As a Prognostic Marker of Long-Term Ventricular Arrhythmias and Cardiac Death in ICD/CRT-D Recipients

Objective To evaluate the PR to RR interval ratio (PR/RR, heart rate-adjusted PR) as a prognostic marker for long-term ventricular arrhythmias and cardiac death in patients with implantable cardioverter defibrillator (ICDs) and cardiac resynchronization therapy with defibrillators (CRT-D). Methods We retrospectively analyzed data from 428 patients who had an ICD/CRT-D equipped with home monitoring. Baseline PR and RR interval data prior to ICD/CRT-D implantation were collected from standard 12-lead electrocardiograph, and the PR/RR was calculated. The primary endpoint was appropriate ICD/CRT-D treatment of ventricular arrhythmias (VAs), and the secondary endpoint was cardiac death. Results During a mean follow-up period of 38.8 +/- 10.6 months, 197 patients (46%) experienced VAs, and 47 patients (11%) experienced cardiac death. The overall PR interval was 160 +/- 40 ms, and the RR interval was 866 +/- 124 ms. Based on the receiver operating characteristic curve, a cut-off value of 18.5% for the PR/RR was identified to predict VAs. A PR/RR >= 18.5% was associated with an increased risk of VAs [hazard ratio (HR) = 2.243, 95% confidence interval (CI) = 1.665-3.022, P < 0.001) and cardiac death (HR = 2.358, 95% CI = 1.240-4.483, P = 0.009) in an unadjusted analysis. After adjustment in a multivariate Cox model, the relationship remained significant among PR/RR >= 18.5%, VAs (HR = 2.230, 95% CI = 1.555-2.825, P < 0.001) and cardiac death (HR = 2.105, 95% CI = 1.101-4.025, P = 0.024. Conclusions A PR/RR >= 18.5% at baseline can serve as a predictor of future VAs and cardiac death in ICD/CRT-D recipients.