Ageing and Atrial Electrophysiologic Properties in Man

Michelucci, Antonio; Padeletti, Luigi; Lova, Raffaele Molino; Fradella, G. A.; Monizzi, D.; Giomi, Andrea; Seniori, P.; Bèrni, G; Fantini, F

doi:10.1007/978-3-642-72367-4_7

Cited by 13 publications

(23 citation statements)

References 12 publications

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“…Indeed, dispersion and lengthening of atrial refractoriness with aging have been reported. [11][12][13] The demonstration of electrophysiologic changes in the atrial muscle with age [14][15][16] is consistent with the concept that electrophysiologic functional changes are related to histologic changes of the conduction system of the heart with advancing age. Michelucci et al suggested that aging modifies atrial refractoriness in a nonuniform manner, inducing a progressing increment of dispersion of atrial refractoriness.…”

Section: Discussionsupporting

confidence: 71%

The effects of aging on atrial endocardial electrograms in patients with paroxysmal atrial fibrillation

Centurión

Isomoto

Shimizu

et al. 2003

Clinical Cardiology

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Background: The prevalence of atrial fibrillation (AF) has been reported to increase with advancing age. Histologic studies in AF have demonstrated that the percentage of fibrosis and degenerative changes in the atrial muscle increase significantly with age. Hypothesis: This study was undertaken to assess the influence of advancing age on atrial endocardial electrograms recorded during sinus rhythm in patients with paroxysmal atrial fibrillation (PAF), which had not been assessed previously. Methods: Right atrial endocardial catheter mapping during sinus rhythm was performed in 111 patients with PAF to evaluate the influence of advancing age onatrial endocardial electrograms. The bipolar electrograms were recorded at 12 sites in the right atrium, and an abnormal atrial electrogram was defined as lasting ≥ 100 ms, and/or showing eight or more fragmented deflections. Results: In all, 1,332 right atrial endocardial electrograms were assessed and measured quantitatively. The number of abnormal atrial electrograms in patients with PAF showed a significantly positive correlation with age (r = 0.34; p<0.0005). Patients aged > 60 years had a significantly greater mean number of abnormal electrograms (2.58 ± 2.05) than those aged < 60 years (1.43 ± 2.03; p<0.004). The longest duration (r = 0.35; p<0.0005) and the maximal number of fragmented deflections (r = 0.29; p<0.005) of atrial electrograms among the 12 right atrial sites also showed a significantly positive correlation with age. Conclusions: Aging alters the electrophysiologic properties of the atrial muscle in patients with PAF. Elderly patients have a significantly greater abnormality of atrial endocardial electrograms than do younger ones. There is a progressive increment in the extension of altered atrial muscle with advancing age in patients with PAF.

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Section: Discussionsupporting

confidence: 71%

The effects of aging on atrial endocardial electrograms in patients with paroxysmal atrial fibrillation

Centurión

Isomoto

Shimizu

et al. 2003

Clinical Cardiology

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“…A positive correlation existed between the right atrial effective refractory period and age in this study, and the right atrial effective refractory period became longer as age increased. Michelucci, et al 3) and Kavanagh,et al 4) also found a similar positive correlation between the right atrial effective refractory period and age. In addition, it has been suggested that this age-related prolongation of right atrial effective refractory period may be affected by age-related changes in the action potential duration, resting membrane potential, and autonomic nervous system.…”

Section: Patient Characteristicsmentioning

confidence: 67%

“…Intracardiac electrograms were recorded (gain 2 mV/cm, filter 30 to 500 Hz) using an electrophysiologic recording system (Cardiolab; Prucka Engineering). To create the atrial vulnerability index, as described subsequently, [1][2][3][4] programmed electrical stimulation using eight basic stimuli at a cycle length of 500 ms followed by extrastimuli was delivered. Basic stimuli and the corresponding atrial deflection were designated S1 and A1, respectively.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2003

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SUMMARYAlthough atrial fibrillation is a common arrhythmia, especially in the elderly, little is known about age-related changes in the electrophysiologic properties of the atrium. The aim of this study was to analyze the effect of aging on atrial vulnerability to atrial fibrillation.An electrophysiologic study was performed in 45 patients with no history of atrial fibrillation, Wolff-Parkinson-White syndrome, structural heart disease, or conditions with potential effects on cardiac hemodynamic or electrophysiologic function (15 females; mean age, 52 ± 18 years; range, 14 to 84 years). The following atrial excitability parameters were assessed: spontaneous or paced (A1) and extrastimulated (A2) atrial electrogram widths, percent maximum atrial fragmentation (A2/A1 × 100), effective refractory period, wavelength index (ERP/A2), and inducibility of atrial fibrillation.Atrial fibrillation was induced in 9 patients. Percent maximum atrial fragmentation was greater (176 ± 36 vs 137 ± 26%, P < 0.001) and wavelength index was shorter (2.4 ± 0.4 vs 3.2 ± 0.9, P < 0.01) in the patients with than without inducible atrial fibrillation.However, age was similar in patients with and without inducible atrial fibrillation (47 ± 11 vs 53 ± 19 years, P = 0.36). Percent maximum atrial fragmentation and effective refractory period directly correlated with age (r = 0.32, P < 0.05 and r = 0.45, P < 0.001, respectively). On the other hand, wavelength index (3.1 ± 0.9) did not correlate with age (r = -0.05, P = 0.77).This study suggests that the mechanism triggering atrial fibrillation may be very well different between older and younger patients with atrial fibrillation, because younger patients have no marked substrate for atrial fibrillation. (Jpn Heart J 2003; 44: 385-393)

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“…The prevalence of tachyarrhythmias has been reported to decrease with age in WPW syndrome (9,12,13). Although its mechanism is uncertain, some degenerative changes of the accessory pathways developing with age and ensuring prolongation of the ERP have been proposed (10,14,15). The manifestation of tachyarrhythmia during Af in WPW syndrome should be a wide QRS tachycardia, when the impulses from the atria that propagate across the accessory pathway capture most of the ventricle.…”

Section: Discussionmentioning

confidence: 99%

Late Onset of Wolff-Parkinson-White Syndrome in a 72-year-old Man

et al. 2004

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We encountered a case of wide QRS tachycardia with chronic atrial fibrillation in Wolff-Parkinson-White syndrome. Unique features were late onset of syncope attacks associated with this tachycardia at an advanced age of 72 years old without previous documentation of WolffParkinson-White syndrome on electrocardiogram. He had a high likelihood of sudden cardiac death. Catheter ablation using CARTO TM system easily led to a successful ablation of the accessory pathway. The mechanism of late onset of the wide QRS tachycardia was attributed to possible changes of electrophysiologic properties including the atrio-ventricular node and/or the accessory pathway, and the unique location of the accessory pathway. Case ReportA 72-year-old man was admitted for evaluation of frequent syncope or fainting attacks which had suddenly begun 1 month before admission in May 2002. He easily experienced syncope attacks on exercise. Thus, his daily life activities were limited. He was taking antihypertensive drugs (5 mg of enalapril and 25 mg of atenolol), digitalis glycosides (0.125 mg of digoxin) and warfarin potassium as anticoagulant therapy for~10 years because of a history of cerebral infarction associated with hypertension and non-valvular chronic atrial fibrillation (Af). An electrocardiogram (ECG) taken 1 year prior to the admission was Af with narrow QRS complex ( Fig. 1A) with no evidence of tachycardia and delta waves (mean heart rate; 64 beats per minute, QRS; 82 msec). While the ECG taken 2 months prior to the admission showed Af with intermittent delta waves (mean heart rate; 60 beats per minute) ( Fig. 2A).On admission, his blood pressure was 102/64 mmHg and pulse rate was 124 beats per minute and irregular. When his heart rate was over 150 beats per minute on exercise, his systolic blood pressure dropped under 70 mmHg with manifestation of fainting. There were no murmurs on cardiac auscultation. Routine blood test results were almost normal except for a coagulation time. An ECG (Fig. 1B) showed wide QRS complex tachycardia (mean heart rate; 138 beats per minute, QRS; 134 msec) with a slur at the initial portion of the QRS complex. This tachycardia was suppressed by an intravenous administration of procainamide, which is known to depress the conduction of the accessory pathway (1), and resulted in a dramatic decrease of the wide QRS complex (Fig. 2B). By contrast, the tachycardia was accelerated by an intravenous application of verapamil or digitalis glycosides (Fig. 2C), which are reported to depress the conduction of the atrio-ventricular (AV) node (2, 3). With this change of ECG, the patient experienced symptoms of hypotension and notable fainting. These findings suggested that this patient might have Wolff-Parkinson-White (WPW) syndrome. A chest radiograph showed a mild increase of the cardiothoracic ratio (CTR; 54%) and two-dimensional echocardiography revealed no evidence of cardiac abnormalities except for mild dilatation of the left atrium, such as Ebstein's anomaly and mitral leaflet prolapse which are...

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Ageing and Atrial Electrophysiologic Properties in Man

Cited by 13 publications

References 12 publications

The effects of aging on atrial endocardial electrograms in patients with paroxysmal atrial fibrillation

The effects of aging on atrial endocardial electrograms in patients with paroxysmal atrial fibrillation

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

Late Onset of Wolff-Parkinson-White Syndrome in a 72-year-old Man

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