Value of frontal QRS axis for risk stratification of individuals with prolonged PR interval

Background There is ongoing controversy regarding the prognostic value of PR prolongation among individuals free of cardiovascular diseases. It is necessary to risk‐stratify this population according to other electrocardiographic parameters. Methods This study is based on the Third National Health and Nutrition Examination Survey. Cox proportional hazard models were constructed and Kaplan–Meier method was used. Results A total of 6188 participants (58.1 ± 13.1 years; 55% women) were included. The median frontal QRS axis of the entire study population was 37° (IQR: 11–60°). PR prolongation was present in 7.6% of the participants, of whom 61.2% had QRS axis ≤37°. In a multivariable‐adjusted model, mortality risk was highest in the group with concomitant prolonged PR interval and QRS axis ≤37° (hazard ratio [HR]: 1.20; 95% confidence interval [CI]: 1.04–1.39). In models with similar adjustment where population were reclassified depending on PR prolongation and QRS axis, prolonged PR interval and QRS axis ≤37° was still associated with increased risk of mortality (HR: 1.18; 95% CI: 1.03–1.36) compared with normal PR interval. Conclusions QRS axis is an important factor for risk stratification in population with PR prolongation. The extent to which this population with PR prolongation and QRS axis ≤37° is at higher risk of death compared with the population without PR prolongation. The QRS axis is an important risk stratification factor for prolongation of the PR interval in people without cardiovascular disease. Evaluation of the QRS axis is particularly necessary in patients whose electrocardiogram suggests prolongation of the PR interval.