Skip to main content
Top
Published in: BMC Cardiovascular Disorders 1/2021

Open Access 01-12-2021 | Atrioventricular Block | Research

Prevalence and risk factors of atrioventricular block among 15 million Chinese health examination participants in 2018: a nation-wide cross-sectional study

Authors: Ruiqi Shan, Yi Ning, Yuan Ma, Siliang Liu, Jing Wu, Xiaohan Fan, Jun Lv, Bo Wang, Shijun Li, Liming Li

Published in: BMC Cardiovascular Disorders | Issue 1/2021

Login to get access

Abstract

Background

Nationwide data on the prevalence of atrioventricular (AV) block are currently unavailable in China. Thus, we aimed to assess the prevalence and risk factors of AV block among Chinese health examination adults.

Methods

A total of 15,181,402 participants aged ≥ 18 years (mean age 41.5 ± 13.4 years, 53.2% men) who underwent an electrocardiogram as a part of routine health examination in 2018 were analyzed. AV block was diagnosed by physicians using 12-lead electrocardiogram. Overall and stratified prevalence (by age, sex, and city size) of all, first-, second- and third-degree AV block were calculated. Multivariable logistic regression analyses were performed to explore risk factors associated with AV block.

Results

AV block was observed in 88,842 participants, including 86,153 with first-degree, 2249 with second-degree and 440 with third-degree AV block. The age- and sex-standardized prevalence rate [95% confidence interval (CI)] of all, first-, second- and third-degree AV block were 7.06‰ (7.01–7.11), 6.84‰ (6.79–6.89), 0.18‰ (0.17–0.18) and 0.04‰ (0.03–0.04) respectively. After multivariable adjustment, the risk of AV block was positively associated with older age, being male, lower heart rate, higher body mass index, hypertension, diabetes and low high-density lipoprotein cholesterol. High total cholesterol was associated with a lower risk of AV block.

Conclusion

First-degree AV block is relatively common while severe AV block is rare in health examination adults. Besides, AV block was highly prevalent among the elderly. The risk of AV block was associated with older age, being male and metabolic factors.
Appendix
Available only for authorised users
Literature
1.
go back to reference Kashou AH, Goyal A, Nguyen T, Chhabra L. Atrioventricular block. StatPearls. Treasure Island: StatPearls Publishing; 2020. Kashou AH, Goyal A, Nguyen T, Chhabra L. Atrioventricular block. StatPearls. Treasure Island: StatPearls Publishing; 2020.
2.
go back to reference Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;51:e1-62.CrossRef Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;51:e1-62.CrossRef
3.
go back to reference Cheng S, Keyes MJ, Larson MG, McCabe EL, Newton-Cheh C, Levy D, et al. Long-term outcomes in individuals with prolonged PR interval or first-degree atrioventricular block. JAMA. 2009;301:2571–7.CrossRef Cheng S, Keyes MJ, Larson MG, McCabe EL, Newton-Cheh C, Levy D, et al. Long-term outcomes in individuals with prolonged PR interval or first-degree atrioventricular block. JAMA. 2009;301:2571–7.CrossRef
4.
go back to reference Crisel RK, Farzaneh-Far R, Na B, Whooley MA. 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;32:1875–80.CrossRef Crisel RK, Farzaneh-Far R, Na B, Whooley MA. 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;32:1875–80.CrossRef
5.
go back to reference Aro AL, Anttonen O, Kerola T, Junttila MJ, Tikkanen JT, Rissanen HA, et al. Prognostic significance of prolonged PR interval in the general population. Eur Heart J. 2014;35:123–9.CrossRef Aro AL, Anttonen O, Kerola T, Junttila MJ, Tikkanen JT, Rissanen HA, et al. Prognostic significance of prolonged PR interval in the general population. Eur Heart J. 2014;35:123–9.CrossRef
6.
go back to reference Knabben V, Chhabra L, Slane M. Third-degree atrioventricular block. StatPearls. Treasure Island: StatPearls Publishing; 2020. Knabben V, Chhabra L, Slane M. Third-degree atrioventricular block. StatPearls. Treasure Island: StatPearls Publishing; 2020.
7.
go back to reference Sutton R. Mobitz type 1 second degree atrioventricular block: the value of permanent pacing in the older patient. Heart. 2013;99:291–2.CrossRef Sutton R. Mobitz type 1 second degree atrioventricular block: the value of permanent pacing in the older patient. Heart. 2013;99:291–2.CrossRef
8.
go back to reference Du Z, Xing L, Lin M, Tian Y, Jing L, Yan H, et al. Prevalence of first-degree atrioventricular block and the associated risk factors: a cross-sectional study in rural Northeast China. BMC Cardiovasc Disord. 2019;19:214.CrossRef Du Z, Xing L, Lin M, Tian Y, Jing L, Yan H, et al. Prevalence of first-degree atrioventricular block and the associated risk factors: a cross-sectional study in rural Northeast China. BMC Cardiovasc Disord. 2019;19:214.CrossRef
9.
go back to reference Qi W, Liu SH, Jin HR. Applicability of the new standard of city-size classification in China. Prog Geogr. 2016;35:47–56.CrossRef Qi W, Liu SH, Jin HR. Applicability of the new standard of city-size classification in China. Prog Geogr. 2016;35:47–56.CrossRef
10.
go back to reference Joint Committee for Guideline Revision. 2018 Chinese Guidelines for Prevention and Treatment of Hypertension—a report of the Revision Committee of Chinese Guidelines for Prevention and Treatment of Hypertension. J Geriatr Cardiol. 2019;16:182–241.PubMedCentral Joint Committee for Guideline Revision. 2018 Chinese Guidelines for Prevention and Treatment of Hypertension—a report of the Revision Committee of Chinese Guidelines for Prevention and Treatment of Hypertension. J Geriatr Cardiol. 2019;16:182–241.PubMedCentral
11.
go back to reference Chang CQ, Chen JW, Chen W, Chen Y, Dou P, Feng Y, et al. Writing committee of expert consensus on overweight/obesity medical nutrition therapy in China. Expert consensus on overweight/obesity medical nutrition therapy in China. Chin J Diabetes Mellitus 2016;8:525–40. Chang CQ, Chen JW, Chen W, Chen Y, Dou P, Feng Y, et al. Writing committee of expert consensus on overweight/obesity medical nutrition therapy in China. Expert consensus on overweight/obesity medical nutrition therapy in China. Chin J Diabetes Mellitus 2016;8:525–40.
12.
go back to reference Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539–53.CrossRef Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539–53.CrossRef
13.
go back to reference Zhu JR, Gao RL, Zhao SP, Lu GP, Zhao D, Li JJ, et al. Joint Committee for Developing Chinese guidelines on Prevention and Treatment of Dyslipidemia in Adults. 2016 Chinese Guidelines for prevention and treatment of dyslipidemia in adults. Chin Circ J 2016;31:937–53. Zhu JR, Gao RL, Zhao SP, Lu GP, Zhao D, Li JJ, et al. Joint Committee for Developing Chinese guidelines on Prevention and Treatment of Dyslipidemia in Adults. 2016 Chinese Guidelines for prevention and treatment of dyslipidemia in adults. Chin Circ J 2016;31:937–53.
14.
go back to reference Hisamatsu T, Miura K, Fujiyoshi A, Okamura T, Ohkubo T, Nagasawa SY, et al. Long-term outcomes associated with prolonged PR interval in the general Japanese population. Int J Cardiol. 2015;184:291–3.CrossRef Hisamatsu T, Miura K, Fujiyoshi A, Okamura T, Ohkubo T, Nagasawa SY, et al. Long-term outcomes associated with prolonged PR interval in the general Japanese population. Int J Cardiol. 2015;184:291–3.CrossRef
15.
go back to reference Hiss RG, Lamb LE. Electrocardiographic findings in 122,043 individuals. Circulation. 1962;25:947–61.CrossRef Hiss RG, Lamb LE. Electrocardiographic findings in 122,043 individuals. Circulation. 1962;25:947–61.CrossRef
16.
go back to reference Kobza R, Cuculi F, Abacherli R, Toggweiler S, Suter Y, Frey F, et al. Twelve-lead electrocardiography in the young: physiologic and pathologic abnormalities. Heart Rhythm. 2012;9:2018–22.CrossRef Kobza R, Cuculi F, Abacherli R, Toggweiler S, Suter Y, Frey F, et al. Twelve-lead electrocardiography in the young: physiologic and pathologic abnormalities. Heart Rhythm. 2012;9:2018–22.CrossRef
17.
go back to reference Ostrander LD Jr, Brandt RL, Kjelsberg MO, Epstein FH. Electrocardiographic findings among the adult population of a total Natural Community, Tecumseh, Michigan. Circulation. 1965;31:888–98.CrossRef Ostrander LD Jr, Brandt RL, Kjelsberg MO, Epstein FH. Electrocardiographic findings among the adult population of a total Natural Community, Tecumseh, Michigan. Circulation. 1965;31:888–98.CrossRef
18.
go back to reference Kojic EM, Hardarson T, Sigfusson N, Sigvaldason H. The prevalence and prognosis of third-degree atrioventricular conduction block: the Reykjavik study. J Intern Med. 1999;246:81–6.CrossRef Kojic EM, Hardarson T, Sigfusson N, Sigvaldason H. The prevalence and prognosis of third-degree atrioventricular conduction block: the Reykjavik study. J Intern Med. 1999;246:81–6.CrossRef
19.
go back to reference Kerola T, Eranti A, Aro AL, Haukilahti MA, Holkeri A, Junttila MJ, et al. Risk factors associated with atrioventricular block. JAMA Netw Open. 2019;2:e194176.CrossRef Kerola T, Eranti A, Aro AL, Haukilahti MA, Holkeri A, Junttila MJ, et al. Risk factors associated with atrioventricular block. JAMA Netw Open. 2019;2:e194176.CrossRef
20.
go back to reference Tadros R, Ton AT, Fiset C, Nattel S. Sex differences in cardiac electrophysiology and clinical arrhythmias: epidemiology, therapeutics, and mechanisms. Can J Cardiol. 2014;30:783–92.CrossRef Tadros R, Ton AT, Fiset C, Nattel S. Sex differences in cardiac electrophysiology and clinical arrhythmias: epidemiology, therapeutics, and mechanisms. Can J Cardiol. 2014;30:783–92.CrossRef
21.
go back to reference Murray CJ, Lopez AD. Measuring the global burden of disease. N Engl J Med. 2013;369:448–57.CrossRef Murray CJ, Lopez AD. Measuring the global burden of disease. N Engl J Med. 2013;369:448–57.CrossRef
22.
go back to reference Cavalera M, Wang J, Frangogiannis NG. Obesity, metabolic dysfunction, and cardiac fibrosis: pathophysiological pathways, molecular mechanisms, and therapeutic opportunities. Transl Res. 2014;164:323–35.CrossRef Cavalera M, Wang J, Frangogiannis NG. Obesity, metabolic dysfunction, and cardiac fibrosis: pathophysiological pathways, molecular mechanisms, and therapeutic opportunities. Transl Res. 2014;164:323–35.CrossRef
23.
go back to reference Meine TJ, Al-Khatib SM, Alexander JH, Granger CB, White HD, Kilaru R, et al. Incidence, predictors, and outcomes of high-degree atrioventricular block complicating acute myocardial infarction treated with thrombolytic therapy. Am Heart J. 2005;149:670–4.CrossRef Meine TJ, Al-Khatib SM, Alexander JH, Granger CB, White HD, Kilaru R, et al. Incidence, predictors, and outcomes of high-degree atrioventricular block complicating acute myocardial infarction treated with thrombolytic therapy. Am Heart J. 2005;149:670–4.CrossRef
24.
go back to reference Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–52.CrossRef Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–52.CrossRef
25.
go back to reference Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104:2746–53.CrossRef Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104:2746–53.CrossRef
26.
go back to reference Lionakis N, Moyssakis I, Gialafos E, Dalianis N, Votteas V. Aortic dissection and third-degree atrioventricular block in a patient with a hypertensive crisis. J Clin Hypertens (Greenwich). 2008;10:69–72.CrossRef Lionakis N, Moyssakis I, Gialafos E, Dalianis N, Votteas V. Aortic dissection and third-degree atrioventricular block in a patient with a hypertensive crisis. J Clin Hypertens (Greenwich). 2008;10:69–72.CrossRef
27.
go back to reference Diez J, Lopez B, Gonzalez A, Querejeta R. Clinical aspects of hypertensive myocardial fibrosis. Curr Opin Cardiol. 2001;16:328–35.CrossRef Diez J, Lopez B, Gonzalez A, Querejeta R. Clinical aspects of hypertensive myocardial fibrosis. Curr Opin Cardiol. 2001;16:328–35.CrossRef
28.
go back to reference Querejeta R, Lopez B, Gonzalez A, Sanchez E, Larman M, Martinez Ubago JL, et al. Increased collagen type I synthesis in patients with heart failure of hypertensive origin: relation to myocardial fibrosis. Circulation. 2004;110:1263–8.CrossRef Querejeta R, Lopez B, Gonzalez A, Sanchez E, Larman M, Martinez Ubago JL, et al. Increased collagen type I synthesis in patients with heart failure of hypertensive origin: relation to myocardial fibrosis. Circulation. 2004;110:1263–8.CrossRef
29.
go back to reference Falcao-Pires I, Leite-Moreira AF. Diabetic cardiomyopathy: understanding the molecular and cellular basis to progress in diagnosis and treatment. Heart Fail Rev. 2012;17:325–44.CrossRef Falcao-Pires I, Leite-Moreira AF. Diabetic cardiomyopathy: understanding the molecular and cellular basis to progress in diagnosis and treatment. Heart Fail Rev. 2012;17:325–44.CrossRef
30.
go back to reference Ganjali S, Gotto AM Jr, Ruscica M, Atkin SL, Butler AE, Banach M, et al. Monocyte-to-HDL-cholesterol ratio as a prognostic marker in cardiovascular diseases. J Cell Physiol. 2018;233:9237–46.CrossRef Ganjali S, Gotto AM Jr, Ruscica M, Atkin SL, Butler AE, Banach M, et al. Monocyte-to-HDL-cholesterol ratio as a prognostic marker in cardiovascular diseases. J Cell Physiol. 2018;233:9237–46.CrossRef
31.
go back to reference Magnussen C, Niiranen TJ, Ojeda FM, Gianfagna F, Blankenberg S, Njolstad I, et al. Sex differences and similarities in atrial fibrillation epidemiology, risk factors, and mortality in community cohorts: results From the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation. 2017;136:1588–97.PubMedPubMedCentral Magnussen C, Niiranen TJ, Ojeda FM, Gianfagna F, Blankenberg S, Njolstad I, et al. Sex differences and similarities in atrial fibrillation epidemiology, risk factors, and mortality in community cohorts: results From the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation. 2017;136:1588–97.PubMedPubMedCentral
32.
go back to reference Guan B, Li X, Xue W, Tse G, Waleed KB, Liu Y, et al. Blood lipid profiles and risk of atrial fibrillation: a systematic review and meta-analysis of cohort studies. J Clin Lipidol. 2020;14:133–42.e3.CrossRef Guan B, Li X, Xue W, Tse G, Waleed KB, Liu Y, et al. Blood lipid profiles and risk of atrial fibrillation: a systematic review and meta-analysis of cohort studies. J Clin Lipidol. 2020;14:133–42.e3.CrossRef
33.
go back to reference Psaty BM, Manolio TA, Kuller LH, Kronmal RA, Cushman M, Fried LP, et al. Incidence of and risk factors for atrial fibrillation in older adults. Circulation. 1997;96:2455–61.CrossRef Psaty BM, Manolio TA, Kuller LH, Kronmal RA, Cushman M, Fried LP, et al. Incidence of and risk factors for atrial fibrillation in older adults. Circulation. 1997;96:2455–61.CrossRef
34.
go back to reference Bastiaanse EM, Hold KM, Van der Laarse A. The effect of membrane cholesterol content on ion transport processes in plasma membranes. Cardiovasc Res. 1997;33:272–83.CrossRef Bastiaanse EM, Hold KM, Van der Laarse A. The effect of membrane cholesterol content on ion transport processes in plasma membranes. Cardiovasc Res. 1997;33:272–83.CrossRef
35.
go back to reference Lijnen P. The effect of membrane cholesterol content on ion transport processes in plasma membranes. Cardiovasc Res. 1997;35:384–6.CrossRef Lijnen P. The effect of membrane cholesterol content on ion transport processes in plasma membranes. Cardiovasc Res. 1997;35:384–6.CrossRef
36.
go back to reference Ravnskov U. High cholesterol may protect against infections and atherosclerosis. QJM. 2003;96:927–34.CrossRef Ravnskov U. High cholesterol may protect against infections and atherosclerosis. QJM. 2003;96:927–34.CrossRef
Metadata
Title
Prevalence and risk factors of atrioventricular block among 15 million Chinese health examination participants in 2018: a nation-wide cross-sectional study
Authors
Ruiqi Shan
Yi Ning
Yuan Ma
Siliang Liu
Jing Wu
Xiaohan Fan
Jun Lv
Bo Wang
Shijun Li
Liming Li
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2021
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-021-02105-3

Other articles of this Issue 1/2021

BMC Cardiovascular Disorders 1/2021 Go to the issue