PR interval

Jump to navigation Jump to search
The PR duration depends on the conduction velocity in the atria, AV node, His bundle, bundle branches and Purkinje fibers.

WikiDoc Resources for PR interval

Articles

Most recent articles on PR interval

Most cited articles on PR interval

Review articles on PR interval

Articles on PR interval in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on PR interval

Images of PR interval

Photos of PR interval

Podcasts & MP3s on PR interval

Videos on PR interval

Evidence Based Medicine

Cochrane Collaboration on PR interval

Bandolier on PR interval

TRIP on PR interval

Clinical Trials

Ongoing Trials on PR interval at Clinical Trials.gov

Trial results on PR interval

Clinical Trials on PR interval at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on PR interval

NICE Guidance on PR interval

NHS PRODIGY Guidance

FDA on PR interval

CDC on PR interval

Books

Books on PR interval

News

PR interval in the news

Be alerted to news on PR interval

News trends on PR interval

Commentary

Blogs on PR interval

Definitions

Definitions of PR interval

Patient Resources / Community

Patient resources on PR interval

Discussion groups on PR interval

Patient Handouts on PR interval

Directions to Hospitals Treating PR interval

Risk calculators and risk factors for PR interval

Healthcare Provider Resources

Symptoms of PR interval

Causes & Risk Factors for PR interval

Diagnostic studies for PR interval

Treatment of PR interval

Continuing Medical Education (CME)

CME Programs on PR interval

International

PR interval en Espanol

PR interval en Francais

Business

PR interval in the Marketplace

Patents on PR interval

Experimental / Informatics

List of terms related to PR interval

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

The PR interval starts at the beginning of the atrial excitation (beginning of the P wave and ends at the beginning of the ventricular excitation (beginning of the QRS complex. It is termed the PQ interval if a Q wave is present. The PR interval measures the time required for an electrical impulse to travel from the atrial myocardium adjacent to the sinoatrial (SA) node to the ventricular myocardium adjacent to the fibers of the Purkinje network.

The duration of the PR interval is normally from 0.10 to 0.21 s. A major portion of the PR interval reflects the slow conduction of an impulse through the AV node, which is controlled by the balance between the sympathetic and parasympathetic divisions of the autonomic nervous system. Therefore, the PR interval varies with the heart rate, being shorter at faster rates when the sympathetic component predominates, and vice versa. The PR interval tends to increase with age;[1] [2]

  • In childhood: 0.10 - 0.20 sec
  • In adolescence: 0.12 - 0.16 sec
  • In adulthood: 0.14 - 0.21 sec

Changes in PR interval

A prolonged PQ interval is a sign of delayed conduction through the atrium and AV node. Pathophysiologically, this can be due to 1st, 2nd or 3rd degree AV block, increased vagal tone [Bezold-Jarisch reflex; described as an eponym for a triad of responses (apnea, bradycardia, and hypotension) following intravenous injection of veratrum alkaloids in experimental animals], or it can be pharmacologically induced.[3] [4]

A short PR interval can be seen in the WPW syndrome in which a faster connection exists between the atria and the ventricles.

  • Shortens up to a rate of 140 to 150 beats per minute through a withdrawal of parasympathetic tone.[5] [6]
  • PR may increase with increasing rate in the presence of digoxin or if the conducting system is diseased.
  • If the atria are artificially paced the PR increases as the paced rate increases.[7]
  • Children have shorter PR intervals (0.11 at 1 year).

80% of the PR prolongations ranged from 0.21 to 0.24.[8] In a second study 59 of 19.000 (0.31%) airmen had a PR of 0.24 or more [9]

  • In healthy middle aged men, a prolongation of the PR in the presence of a normal QRS does not affect prognosis and is not related to ischemic heart disease.[10]
  • Prolongation can be a normal variant: 67.000 healthy airmen studied and 0.52% found to have a prolonged PR.
  • PR prolongation often signifies a delay in the AV node but may reflect intra atrial or His Purkinje disease.

Differential Diagnosis of the Shortened PR Interval

Differential Diagnosis of a Prolonged PR Interval

Differential Diagnosis of the Depressed PR Interval

References

  1. Beckwith JR. Grant's clinical electrocardiography. New York: McGraw–Hill, 1970:50.
  2. Marriott's Practical Electrocardiography, Wagner G.S., 10th edition, 2001
  3. Aviado DM, Guevara Aviado D. The Bezold-Jarisch reflex: A historical perspective of cardiopulmonary reflexes, Ann N Y Acad Sci. 2001 Jun; 940: 48-58
  4. Mark AL. The Bezold-Jarisch reflex revisited: clinical implications of inhibitory reflexes originating in the heart. J Am Coll Cardiol. 1983 Jan;1 (1): 90-102.
  5. Chou's Electrocardiography in Clinical Practice.
  6. Atterhog, J. Electrocardiol. 1977:10,331.
  7. Lister,J., Am.J. Cardiol 1965:16,516.
  8. Johnson, R, Am. J. Cardiol. 1960:6,153.
  9. Manning, G., Am. J. Cardiol.1962:9,558.
  10. Erikssen, J.,Clin.Card. 1984:7,6.
  11. Marriott's Practical Electrocardiography
  12. Goldberger's Clinical Electrocardiography


Template:WikiDoc Sources