Age-Related Changes in the Electrophysiologic Properties of the Atrium in Patients with no History of Atrial Fibrillation

Sakabe, Koichi; Fukuda, Nobuo; Nada, Teru; Shinohara, Hisanori; Tamura, Yoshiyuki; Wakatsuki, Tetsuzo; Nishikado, Akiyoshi; Oki, Takashi

doi:10.1536/jhj.44.385

Cited by 18 publications

(13 citation statements)

References 23 publications

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“…Interactions of age as a continuous variable: CAI >5, P = 0.04; CSA-CSR, P = 0. the effects of advanced age and SDB may be multiplicative. For example, the pathophysiologic insults of SDB, including intermittent hypoxia, autonomic imbalance, and intrathoracic pressure swings, may have more pronounced effects on atrial arrhythmogenesis when superimposed on the aged heart, which has an electrophysiologic substrate different from that of younger individuals (47)(48)(49)(50)(51). Enhanced impulse generation due to increased automaticity, triggered activity, and reentrant circuits within the atria and pulmonary veins are considered to be responsible for AF initiation and maintenance in the elderly and at a specific age threshold may be more likely to occur as a pathophysiologic response to SDB-induced physiologic stress (48,50,52).…”

Section: Discussionmentioning

confidence: 99%

Central Sleep-disordered Breathing Predicts Incident Atrial Fibrillation in Older Men

May

Blackwell

Stone

et al. 2016

Am J Respir Crit Care Med

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Rationale: Although research supports a sleep-disordered breathing and atrial fibrillation association, prospective data examining sleepdisordered breathing predicting incident atrial fibrillation are lacking.Objectives: To investigate sleep-disordered breathing indices as predictors of incident atrial fibrillation.Methods: A cohort (n = 843) of ambulatory older men without prevalent atrial fibrillation was assessed for baseline sleep indices: apnea-hypopnea index, central sleep apnea (central apnea index, >5 vs. ,5), central sleep apnea or Cheyne-Stokes respiration, obstructive apnea-hypopnea index, and percentage of sleep time with less than 90% oxygen saturation. Incident clinically symptomatic adjudicated or self-reported atrial fibrillation outcome was ascertained (mean follow-up, 6.5 6 0.7 yr). We used logistic regression models adjusted for age, race, body mass index, cardiopulmonary disease, alcohol use, pacemaker, cholesterol, cardiac medications, and alternate apnea type for obstructive and central apnea. Age interaction terms and median age-stratified analyses were performed. Conclusions: In older men, central apnea and Cheyne-Stokes respiration predicted increased atrial fibrillation risk, with findings being strongest in older participants in whom overall sleepdisordered breathing also increased atrial fibrillation risk.

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Section: Discussionmentioning

confidence: 99%

Central Sleep-disordered Breathing Predicts Incident Atrial Fibrillation in Older Men

May

Blackwell

Stone

et al. 2016

Am J Respir Crit Care Med

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“…[39–44] Both effective refractory period, which primes the heart for atrial reentrant circuits, and percent maximum atrial fragmentation, a measure reflective of AF inducibility, correlated with age in participants with no risk factors for AF. [41,42,45,46] Other work showed significant pulmonary vein electroanatomic changes with age which may be secondary to age-related atrial fibrosis. [29,44,47,48] Previous work on this topic has not examined the effects of age on the PLMS-AF relationship.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal relationships of periodic limb movements during sleep and incident atrial fibrillation

et al. 2016

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Objectives Examine relationships of periodic limb movements during sleep (PLMS) and incident atrial fibrillation/flutter (AF). Methods Prospective multicenter cohort (n=2,273: adjudicated AF group, n=843: self-reported AF group) of community-dwelling men without prevalent AF were followed an average of 8.3yr (adjudicated) and 6.5yr (self-reported). PLMS index (PLMI, <5 (ref), ≥5 to <30, ≥30) and PLM arousal index (PLMAI, <1 (ref), ≥1 to <5, ≥5) were measured by polysomnography. Incident adjudicated and self-reported AF were analyzed via Cox proportional hazards or logistic regression, respectively, and adjusted for age, clinic, race, body mass index, alcohol use, cholesterol level, cardiac medications, pacemaker, apnea-hypopnea index, renal function, and cardiac risk. The interaction of age and PLMS was examined. Results In this primarily Caucasian (89.8%) cohort of older men (mean age 76.1±5.5 years) with BMI of 27.2±3.7, there were 261 cases (11.5%) of adjudicated and 85 cases (10.1%) of self-reported incident AF. In the overall cohort, PLMI and PLMAI were not associated with adjudicated or self-reported AF. There was some evidence of an interaction of age and PLMI (p=0.08, adjudicated AF) and PLMAI (p≤0.06, both outcomes). Among men aged≥76, the highest PLMI tertile was at increased risk of adjudicated AF (≥30 vs. <5; HR=1.63, 1.01-2.63) and the middle PLMAI tertile predicted increased risk of both outcomes (1 to <5 vs. <1; adjudicated, HR=1.65, 1.05-2.58; self-reported HR=5.76, 1.76-18.84). No associations were found in men<76. Conclusions Although PLMS do not predict AF incidence in the overall cohort, findings suggest PLMS increases incident AF risk in the older subgroup.

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“…Whilst most animal and human studies have shown that aged atria have an increased propensity to develop AF [87–93], some studies in elderly AF patients have yielded conflicting results although these could have been influenced by underlying pathology or treatment in patients [94–96]. Increased atrial ERP has been noted in these studies which could be sufficient to overcome any other arrhythmogenic remodelling.…”

Section: Electrophysiological and Structural Alterations In Aged Amentioning

confidence: 99%

Comparison of Atrial Fibrillation in the Young versus That in the Elderly: A Review

Sankaranarayanan

Kirkwood

Dibb

et al. 2013

Cardiology Research and Practice

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The incidence and prevalence of atrial fibrillation (AF) are projected to increase significantly worldwide, imposing a significant burden on healthcare resources. The disease itself is extremely heterogeneous in its epidemiology, pathophysiology, and treatment options based on individual patient characteristics. Whilst ageing is well recognised to be an independent risk factor for the development of AF, this condition also affects the young in whom the condition is frequently symptomatic and troublesome. Traditional thinking suggests that the causal factors and pathogenesis of the condition in the young with structurally normal atria but electrophysiological “triggers” in the form of pulmonary vein ectopics leading to lone AF are in stark contrast to that in the elderly who have AF primarily due to an abnormal substrate consisting of fibrosed and dilated atria acting in concert with the pulmonary vein triggers. However, there can be exceptions to this rule as there is increasing evidence of structural and electrophysiological abnormalities in the atrial substrate in young patients with “lone AF,” as well as elderly patients who present with idiopathic AF. These reports seem to be blurring the distinction in the pathophysiology of so-called idiopathic lone AF in the young versus that in the elderly. Moreover with availability of improved and modern investigational and diagnostic techniques, novel causes of AF are being reported thereby seemingly consigning the diagnosis of “lone AF” to a rather mythical existence. We shall also elucidate in this paper the differences seen in the epidemiology, causes, pathogenesis, and clinical features of AF in the young versus that seen in the elderly, thereby requiring clearly defined management strategies to tackle this arrhythmia and its associated consequences.

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Age-Related Changes in the Electrophysiologic Properties of the Atrium in Patients with no History of Atrial Fibrillation

Cited by 18 publications

References 23 publications

Central Sleep-disordered Breathing Predicts Incident Atrial Fibrillation in Older Men

Central Sleep-disordered Breathing Predicts Incident Atrial Fibrillation in Older Men

Longitudinal relationships of periodic limb movements during sleep and incident atrial fibrillation

Comparison of Atrial Fibrillation in the Young versus That in the Elderly: A Review

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