Bradyarrhythmias in the Elderly

Kumar, Preetham; Kusumoto, Fred; Goldschlager, Nora

doi:10.1016/j.cger.2012.08.004

Cited by 28 publications

(23 citation statements)

References 33 publications

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“…22 Indeed, in addition to aortic stenosis, candidates for TAVR currently usually have a high comorbidity burden, which further increases the risk of arrhythmic events and conduction disorders. [3][4][5][6][7][8]12,25 In fact, and consistent with previous studies, 26-29 39% of patients included had known AF/AT, and 14.3% of them had advanced AVB or severe bradycardia with PPI before TAVR. In addition, previously unknown events were encountered in nearly 1 of 5 patients during 24-hour ECG monitoring, leading to a real prevalence of AF/AT and advanced AVB or severe bradycardia before TAVR (previously and newly diagnosed) in this study of 45% and 17%, respectively.…”

Section: Discussionsupporting

confidence: 73%

Arrhythmia Burden in Elderly Patients With Severe Aortic Stenosis as Determined by Continuous Electrocardiographic Recording

et al. 2015

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T he occurrence of new conduction abnormalities and the need for permanent pacemaker implantation (PPI) are frequent complications of transcatheter aortic valve replacement (TAVR) and may potentially jeopardize the use of this technology in a lower-risk and younger population. 1,2 In addition to the aortic stenosis itself, it has been shown that advanced age and comorbidities such as heart failure, hypertension, and diabetes mellitus, all of which are very frequent in candidates for TAVR, are associated with a high prevalence of left bundle-branch block (LBBB) and severe bradyarrhythmias, irrespective of TAVR.3-8 Furthermore, it is well known that these conduction disorders may be paroxysmal and asymptomatic 9 or lead to symptoms similar to those of aortic stenosis, and the occurrence of these abnormalities may therefore be overlooked unless ECG Background-This study sought to evaluate the prevalence of previously undiagnosed arrhythmias in candidates for transcatheter aortic valve replacement (TAVR) and to determine the impact on therapy changes and arrhythmic events after the procedure. Methods and Results-A total of 435 candidates for TAVR underwent 24-hour continuous ECG monitoring the day before the procedure. Newly diagnosed arrhythmias were observed in 70 patients (16.1%) before TAVR: paroxysmal atrial fibrillation (AF)/atrial tachycardia (AT) in 28, advanced atrioventricular block or severe bradycardia in 24, nonsustained ventricular tachycardia in 26, and intermittent left bundle-branch block in 3 patients. All arrhythmic events but one were asymptomatic and led to a therapy change in 43% of patients. In patients without known AF/AT, the occurrence of AF/AT during 24-hour ECG recording was associated with a higher rate of 30-day cerebrovascular events (7.1% versus 0.4%; P=0.030). Among the 53 patients with new-onset AF/AT after TAVR, 30.2% had newly diagnosed paroxysmal AF/AT before the procedure. In patients who needed permanent pacemaker implantation after the procedure (n=35), 31.4% had newly diagnosed advanced atrioventricular block or severe bradycardia before TAVR. New-onset persistent left bundle-branch block after TAVR occurred in 37 patients, 8.1% of whom had intermittent left bundle-branch block before the procedure. Conclusions-Newly diagnosed arrhythmias were observed in approximately a fifth of TAVR candidates, led to a higher rate of cerebrovascular events, and accounted for a third of arrhythmic events after the procedure. This high arrhythmia burden highlights the importance of an early diagnosis of arrhythmic events in such patients to implement the appropriate therapeutic measures earlier.

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Section: Discussionsupporting

confidence: 73%

Arrhythmia Burden in Elderly Patients With Severe Aortic Stenosis as Determined by Continuous Electrocardiographic Recording

et al. 2015

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“…If an arrhythmia results in the slowing of heart the rhythm, it often manifests as lower blood pressure and might cause lightheadedness, dizziness or syncope. The most common are bradyarrhythmia‐related diseases, such as sinus node dysfunction (SND) and atrio‐ventricular blocks (AVD) . Because of its prognostic role, a team approach for the identification of frailty seems to be crucial in elderly patients with cardiac arrhythmias, although there is no research that has evaluated this.…”

Section: Introductionmentioning

confidence: 99%

Frailty syndrome in patients with heart rhythm disorders

Młynarska

Młynarski

Gołba

2016

Geriatrics Gerontology Int

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Frailty syndrome was diagnosed in one-quarter of patients with cardiac arrhythmias, whereas a further 40% were at a higher risk of frailty syndrome, and its occurrence was significantly higher if compared with the control group. Frailty occurred significantly more often among patients with atrio-ventricular blocks, especially in women. The results of the present research showed that there is a statistical association between frailty and arrhythmias. Geriatr Gerontol Int 2017; 17: 1313-1318.

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“…There are several features related to cardiovascular senescence, ranging from decreased left ventricular compliance due to collagen accumulation and fibrosis to alterations in the conduction system, with reduction in pacemaker cells and fatty infiltration, leading to loss of specialized fibers and intrinsic decrease in sinus automatism 10,11 . Moreover, dynamic histochemical and immunohistochemical alterations during the aging process are associated with autonomic reactions involved in the reduction of heart rate in the elderly 12 , resulting in diagnostic and therapeutic implications 13 .…”

Section: Introductionmentioning

confidence: 99%

Does the Aging Process Significantly Modify the Mean Heart Rate?

Santos¹,

Sousa²,

Reis³

et al. 2013

Arquivos Brasileiros De Cardiologia

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BackgroundThe Mean Heart Rate (MHR) tends to decrease with age. When adjusted for gender and diseases, the magnitude of this effect is unclear. ObjectiveTo analyze the MHR in a stratified sample of active and functionally independent individuals. MethodsA total of 1,172 patients aged ≥ 40 years underwent Holter monitoring and were stratified by age group: 1 = 40-49, 2 = 50-59, 3 = 60-69, 4 = 70-79, 5 = ≥ 80 years. The MHR was evaluated according to age and gender, adjusted for Hypertension (SAH), dyslipidemia and non-insulin dependent diabetes mellitus (NIDDM). Several models of ANOVA, correlation and linear regression were employed. A two-tailed p value <0.05 was considered significant (95% CI). ResultsThe MHR tended to decrease with the age range: 1 = 77.20 ± 7.10; 2 = 76.66 ± 7.07; 3 = 74.02 ± 7.46; 4 = 72.93 ± 7.35; 5 = 73.41 ± 7.98 (p < 0.001). Women showed a correlation with higher MHR (p <0.001). In the ANOVA and regression models, age and gender were predictors (p < 0.001). However, R2 and ETA2 < 0.10, as well as discrete standardized beta coefficients indicated reduced effect. Dyslipidemia, hypertension and DM did not influence the findings. ConclusionThe MHR decreased with age. Women had higher values of MHR, regardless of the age group. Correlations between MHR and age or gender, albeit significant, showed the effect magnitude had little statistical relevance. The prevalence of SAH, dyslipidemia and diabetes mellitus did not influence the results.

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Bradyarrhythmias in the Elderly

Cited by 28 publications

References 33 publications

Arrhythmia Burden in Elderly Patients With Severe Aortic Stenosis as Determined by Continuous Electrocardiographic Recording

Arrhythmia Burden in Elderly Patients With Severe Aortic Stenosis as Determined by Continuous Electrocardiographic Recording

Frailty syndrome in patients with heart rhythm disorders

Does the Aging Process Significantly Modify the Mean Heart Rate?

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