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

Abstract

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.

Is there an association between the prevalence of atrial fibrillation and severity and control of hypertension? The REasons for Geographic And Racial Differences in Stroke study

“…Moreover, familial causes, obesity, alcohol, sports and physical activity are associated with AF in young adults, which may partly explain increased AF prevalence among persons < 70 years. 40–44 In terms of race, we found that after full adjustment blacks compared with whites with controlled aTRH had a significantly higher prevalence of AF, suggesting that racial differences persist in controlled aTRH even after adjusting for known confounding factors. These findings are in contrast to the previous studies, which showed increased prevalence of AF in whites compared with blacks; however, these studies either excluded persons with RHTN or were not stratified based on BP control and treatment resistance.…”

Atrial Antitachycardia Pacing in Complex Congenital Heart Disease: A Case Series

“…This is in contrast with ATP therapy in the structurally normal heart for the management of complex atrial flutter and atrial fibrillation, where efficacy has been more limited. 9,10 That being said, efficacy in the CHD population varies based on individual arrhythmia substrates, cardiac anatomy, and medical compliance.…”

Burden of disease from atrial fibrillation in adults from seven countries in Latin America

“…Among hospitalized patients, the data show that a high percentage (21%) of patients with AF receive no prophylactic treatment for reducing stroke risk. Older patients with AF are at a higher risk of bleeding than younger patients, and this can dissuade physicians from prescribing oral anticoagulation 44. While this and other potential reasons, including cost and other issues, might explain the high proportion of patients not receiving anticoagulation, there is no way of positively identifying the reasons from the data available.…”