What does a PR (PQ) interval of 202 ms on an electrocardiogram (ECG) indicate?

What Does a PR Interval of 202 ms Mean on ECG?

A PR interval of 202 ms represents mild first-degree atrioventricular (AV) block, which is technically abnormal but generally benign in asymptomatic individuals without structural heart disease. 1

Understanding the Measurement

The PR interval measures the time from the onset of atrial depolarization (beginning of the P wave) to the onset of ventricular depolarization (beginning of the QRS complex). 1

• Normal range: 120-200 ms 1
• Your value: 202 ms - just 2 milliseconds beyond the upper limit of normal
• First-degree AV block definition: PR interval >200 ms 1

Clinical Significance in Your Case

For Asymptomatic Individuals

If you have no symptoms and no structural heart disease, this finding requires no specific treatment or restriction from activities. 2

• According to ACC/AHA guidelines, first-degree AV block with PR <300 ms is classified as a minor abnormality that does not typically indicate significant cardiac pathology 2
• Your PR of 202 ms is barely prolonged and falls well below the 300 ms threshold where closer evaluation becomes warranted 2

For Athletes

Athletes with first-degree AV block and PR intervals <300 ms can participate in all competitive sports without restriction, provided they are asymptomatic and have no structural heart disease. 2

• First-degree AV block is common in well-conditioned athletes due to increased vagal tone 2
• In athletes, PR intervals up to 400 ms may be physiologically normal 1

When to Be Concerned

While your specific value is minimally prolonged, you should be aware of situations requiring further evaluation:

Symptoms That Matter

If you experience exercise intolerance, palpitations, lightheadedness, or syncope, further evaluation is warranted regardless of the PR interval. 3, 4

• Marked first-degree AV block (PR ≥300 ms) can produce "pseudo-pacemaker syndrome" with symptoms similar to actual pacemaker malfunction 3, 4
• Your PR of 202 ms is unlikely to cause symptoms on its own

Long-Term Prognostic Implications

While traditionally considered benign, population studies show that even mild PR prolongation carries modest long-term risks. 5, 6

• The Framingham Heart Study found that each 20-millisecond increment in PR interval was associated with increased risks of atrial fibrillation (HR 1.11), pacemaker implantation (HR 1.22), and all-cause mortality (HR 1.08) 5
• In patients with established coronary artery disease, first-degree AV block (PR ≥220 ms) was associated with increased heart failure hospitalization and mortality 6
• However, these are population-level associations with small absolute risk increases, not immediate clinical concerns for an individual with PR of 202 ms

Recommended Approach

Immediate Management

No immediate intervention is needed for a PR interval of 202 ms in an asymptomatic person. 2

When Further Testing Is Indicated

Consider additional evaluation if: 2

• QRS duration is abnormal (suggesting infranodal conduction disease)
• PR interval ≥300 ms (marked first-degree AV block)
• Any symptoms are present (exercise intolerance, syncope, palpitations)
• Structural heart disease is suspected on examination or ECG

Appropriate Testing When Needed

If further evaluation is warranted: 2

• Exercise stress test - to assess if PR interval shortens appropriately with activity (it should)
• Echocardiogram - if structural heart disease is suspected
• 24-hour ambulatory monitor - if symptoms are intermittent or if progression to higher-degree block is suspected
• Electrophysiology study - rarely needed, reserved for cases with exercise-induced AV block or suspected infra-His disease 2

Common Pitfalls to Avoid

Do not overreact to minimally prolonged PR intervals. 2

• A PR of 202 ms is only 2 ms beyond normal and does not warrant extensive workup in asymptomatic individuals
• Avoid unnecessary testing that may lead to incidental findings and patient anxiety
• Focus on symptoms and associated ECG findings rather than isolated minimal PR prolongation

Do not ignore symptoms if they develop. 3, 4

• While your current PR is minimally prolonged, if you develop exercise intolerance or syncope, reassessment is needed
• Progressive PR prolongation over time may warrant closer monitoring