Epidemiology of Arrhythmias and Conduction Disorders in Older Adults
Section snippets
Effects of aging on the conduction system, associated conduction disorders, and bradyarrhythmias
Aging affects the cardiovascular system in multiple ways, including a decrease in compliance of blood vessels through arterial stiffening and thickening, mild left ventricular thickening, and a shift in the balance of early versus late diastolic filling. Many of these changes result, in part, from cardiac cell enlargement with apoptosis of neighboring cells and subsequent fibrofatty infiltration of the myocardium.1 The conduction system of the heart is also affected by the latter, producing
Sinoatrial node
Aging is associated with increased fat and collagen deposition surrounding the sinoatrial (SA) node, which may result in delay of action potential propagation or even complete electrical separation of the node from surrounding tissue. During the course of normal aging, the number of pacemaker cells in the SA node declines significantly after age 60 years, with less than 10% of the cells seen in young adults remaining by age 75 years. Paradoxically, although older adults generally have fewer SA
AV node and the His-Purkinje system
Aging results in varying degrees of calcification of the cardiac skeleton, particularly in the region including the central fibrous body and the left-sided valves (aortic and mitral valve rings). The AV node, AV bifurcation, as well as the proximal left and right bundle branches are located near the central fibrous body, and are thus vulnerable to slowed signal transmission with increasing age-related changes.
The PR interval undergoes a modest but significant prolongation with advancing age. In
Tachyarrhythmias
Tachyarrhythmias form a large heterogeneous group of disorders in older adults. The epidemiology of supraventricular and ventricular tachyarrhythmias in the elderly population is discussed in the following sections.
Summary
Aging is associated with a myriad of changes in the cardiac conduction system, some of which manifest in association with cardiovascular disease, and others develop as part of normal aging. These changes include sinus node dysfunction, slowing of AV nodal conduction, left axis deviation, bundle branch blocks, and an increased prevalence of both supraventricular and ventricular premature beats and arrhythmias. LBBB, AF, and sustained VT are particularly predictive of future adverse cardiac
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Disclosures and financial support: The authors have no disclosures or financial conflicts of interest relevant to this manuscript to report. All authors contributed to the writing, editing, and content of this manuscript. The views expressed do not necessarily reflect those of the National Institutes of Health or the Department of Health and Human Services.
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Author contributions: Grant Chow, MD, contributed in drafting and critical revision of the article. Joseph Marine, MD, and Jerome Fleg, MD, critically revised and approved the article for submission.