Aged atria: electrical remodeling conducive to atrial fibrillation

Dun, Wen; Boyden, Penelope A.

doi:10.1007/s10840-008-9358-3

Cited by 70 publications

(58 citation statements)

References 30 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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“…More specifically, the presence of AF in hypertensive patients was associated with an increased LA size and elevated serum levels of UA. Increased LA size is a wellknown factor that facilitates the initiation and perpetuation of AF and is related to atrial remodeling (1,(19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

Uric Acid Levels and Atrial Fibrillation in Hypertensive Patients

et al. 2011

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Objective Uric acid (UA) is a cardiovascular risk marker associated with oxidative stress and inflammation. Recently, atrial fibrillation (AF) has been associated with inflammation and oxidative stress. The objective of this observational study was to investigate the association between UA levels and AF in hypertensive patients. Methods Consecutive patients with hypertension were screened. We excluded subjects with coronary artery disease, congestive heart failure, diabetes, valvular heart disease, congenital heart disease, cardiomyopathy, renal failure, inflammatory conditions, thyroid dysfunction, respiratory diseases, and those who were taking drugs that affect UA metabolism (apart from diuretics). The final study population consisted of 451 patients. Fifty of them (11%) had AF (paroxysmal: 38; persistent: 8; permanent: 4). Demographic, clinical, laboratory, and echocardiographic characteristics were carefully recorded. Results After univariate analysis, age, duration of hypertension, serum creatinine, serum UA, left atrial diameter (LAD), interventricular septum thickness, and left ventricular posterior wall thickness were significantly increased in patients with AF compared with non-AF patients, while the estimated glomerular filtration (eGFR) level was much lower in patients with AF than in those without AF. After multivariate logistic regression analysis, the independent predictors of AF were UA (OR: 1.008; 95% CI: 1.003-1.013, p=0.002) and LAD (OR: 1.160; 95% CI: 1.068-1.260; p<0.001). Conclusion We demonstrated an independent association between increased serum UA levels and AF in hypertensive patients. Undoubtedly, larger studies in different populations should further examine this potential association as well as the underlying pathophysiological mechanisms.

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“…Similarly, basal calcium current reduction in aged cells was unaccompanied by changes in calcium channel availability or recovery from inactivation. Therefore, it is unlikely that conduction changes in aged atrial tissues are due to changes in intrinsic channel function, but rather due to the complex interplay between age-related fibrosis and a trigger mechanism for initiation and propagation of dysrhythmias (6). …”

Section: Pathophysiology Of Arrhythmias In the Elderlymentioning

confidence: 99%

Arrhythmias in Patients ≥80 Years of Age

Curtis

Karki

Hattoum

et al. 2018

Journal of the American College of Cardiology

109

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Advances in medical care have led to an increase in the number of octogenarians and even older patients, forming an important and unique patient subgroup. It is clear that advancing age is an independent risk factor for the development of most arrhythmias, causing substantial morbidity and mortality. Patients ≥80 years of age have significant structural and electrical remodeling of cardiac tissue; accrue competing comorbidities; react differently to drug therapy; and may experience falls, frailty, and cognitive impairment, presenting significant therapeutic challenges. Unfortunately, very old patients are under-represented in clinical trials, leading to critical gaps in evidence to guide effective and safe treatment of arrhythmias. In this state-of-the-art review, we examine the pathophysiology of aging and arrhythmias and then present the available evidence on age-specific management of the most common arrhythmias, including drugs, catheter ablation, and cardiac implantable electronic devices.

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Aged atria: electrical remodeling conducive to atrial fibrillation

Cited by 70 publications

References 30 publications

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

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

Uric Acid Levels and Atrial Fibrillation in Hypertensive Patients

Arrhythmias in Patients ≥80 Years of Age

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