ESC Congress 2026 Abstract · Oct 26, 2026
N-terminal pro-B-type natriuretic peptide predicts atrioventricular block risk: a prospective population-based cohort study
By Chung H, Yang P, Kim M et al.
Background: Mechanical stress is associated with myocardial interstitial fibrosis and electrophysiological impairment. N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) is a biomarker of pressure or volume overload. Purpose: To investigate the association between NT-proBNP and the risk of atrioventricular (AV) block. Methods: 50,331 participants from the UK Biobank cohort involved in the Pharma Proteomics Project with no history of AV block or cardiac implantable electronic devices were analyzed. The primary outcome was a composite of second-degree AV block, third-degree AV block, or AV block-related pacemaker implantation. Secondary outcomes included each component of the primary outcome. We estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) across quartiles of NT-proBNP using generalized propensity score weighting. Results: The mean age was 57.3 years, and 45.9% were men. During the median 11.8-year follow-up, 352 primary outcomes occurred. The highest NT-proBNP quartile, relative to the lowest, was associated with a 2.13-fold higher risk of the primary outcome (HR: 2.13, 95% CI: 1.46–3.11). Among individual components of the primary outcome, the highest NT-proBNP quartile, relative to the lowest, was associated with a 2.49-fold higher risk of third-degree AV block (HR: 2.49, 95% CI: 1.50–4.15) and a 3.13-fold higher risk of AV block-related pacemaker implantation (HR: 3.13, 95% CI: 1.81–5.43). Associations were consistent when NT-proBNP was treated as a continuous variable and across subgroups. Higher NT-proBNP levels were associated with elevated LVEDV and QRS prolongation. Conclusions: Higher NT-proBNP levels were associated with an increased risk of AV block, likely reflecting cardiac conduction vulnerability.Association of NT-proBNP With OutcomesNTproBNP & Elevated LVEDV or QRS Prolongation