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To the Editor: Dr Cheng and colleagues¹ demonstrated that PR interval prolongation is associated with an increased risk of future AF, need for pacemaker implantation, and all-cause mortality. To help validate this study and determine whether its findings can be incorporated into clinical practice, it would be helpful to have a number of pieces of information about associated conditions that could have contributed to PR prolongation and its outcomes.

The authors included pacemaker implantation as one of the variables because it might act as a surrogate for advanced conduction system disease. However, the requirements for pacemaker in these patients were not clearly described. The only predisposing conditions noted were high-grade AV nodal block (present in 36% of the participants) and sinus node dysfunction (present in 53%). Other conduction abnormalities in association with PR prolongation, which by themselves could lead to pacemaker placement and to all-cause mortality,² were not addressed.

Although . . . [Full Text of this Article]

Vijay Arun Doraiswamy, MD
temple007@gmail.com
Department of Internal Medicine
University of Arizona College of Medicine
Tucson

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