Electrophysiologic and electroanatomic changes in the human atrium associated with age

Abstract

Aging is associated with regional conduction slowing, anatomically determined conduction delay at the crista, and structural changes that include areas of low voltage. In addition, impairment of sinus node function and an increase in atrial ERP occurred with aging. This electrical and structural remodeling may explain the increased propensity to AF with aging.

Regional left atrial voltage in patients with atrial fibrillation

“…11 Finally, given the greater incidence of AF in older patients, the group tested the hypothesis that right atrial voltage would be lower in older patients by studying 13 patients ≥60 years old, 13 patients between 31 and 59 years old, and 13 patients ≤30 years old: once again, they found lower right atrial voltage and greater heterogeneity in their study group (the older patients). 13 Corradi et al found a greater amount of interstitial fibrosis in the posterior wall compared to the left atrial appendage in AF patients undergoing mitral valve surgery. 6 Our findings suggest that the regional differences may be exaggerated in AF patients.…”

“…9 Low voltage detected by CARTO accurately correlates with areas of fibrosis, 10 and studies examining voltage in the right atrium have demonstrated lower voltage in patients with sinus node disease, 11 congestive heart failure, 12 and advancing age. 13 Previous studies involving left atrial anatomic maps of AF patients have explored the value of targeting complex and high-frequency activity during AF 7, 14 and the prognostic significance of large areas of scarring in AF patients, 15 but none have examined sinus rhythm maps to characterize regional voltage.…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…14,587,1098,1099 The results of a subset of these studies suggest that AF can be viewed, in some patients, as a rate-related atrial cardiomyopathy. As discussed elsewhere in the document, AF can also follow and be the consequence of prior atrial damage and fibrosis (atrial myopathy).…”

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

“…165,166 Clinical mapping studies have also demonstrated similar findings of conduction abnormalities, prolonged refractoriness, reduced myocardial voltage, and a greater number of double potentials and fractionated electrograms. 167,168 Perhaps as a result of these atrial changes, alteration of wavefront propagation velocities has been described with an inverse correlation to age. 169 Histologically, fibrotic changes are the most obvious alteration (EHRAS Class II; see Table 2).…”

“…167 It has been a powerful research tool that has enhanced our understanding of the atrial substrate in patients with paroxysmal and persistent atrial fibrillation and 74,434 those who have failed initial PV antrum isolation. 435 Unlike cardiac MR, CT, or echocardiography, EAM requires invasive catheterization and mapping.…”