Clinical electrophysiology of the aging heart

ABSTRACT

Introduction

Advancements in medical and consumer-grade technologies have made it easier than ever to monitor a patient’s heart rhythm and to diagnose arrhythmias. Octogenarians with symptomatic arrhythmias have unique management challenges due to their frailty, complex drug interactions, cognitive impairment, and competing comorbidities. The management decisions are further complicated by the lack of randomized evidence to guide treatment.

Areas Covered

A comprehensive literature review was undertaken to outline various tachyarrhythmias and bradyarrhythmias and their management, the role of cardiac implantable electronic devices, cardiac ablations, and specific geriatric arrhythmia considerations as recommended in international guidelines.

Expert Opinion

Atrial fibrillation (AF) is arguably the most important arrhythmia in the elderly and is associated with significant morbidity and mortality. Early diagnosis of AF, potentially with smart devices (wearables), has the potential to reduce the incidence of stroke, systemic emboli, and the risk of dementia. Bradyarrhythmias have a high incidence in the elderly as well, often requiring implantation of a permanent pacemaker. Leadless pacemakers implanted directly into the right ventricle are great options for gaining traction in elderly patients.

KEYWORDS:

• elderly
• geriatrics
• arrhythmias
• ablation
• antiarrhythmic drugs
• electrophysiology
• pacemaker

Article highlights

• With aging, the heart undergoes complex remodeling due to changes in the cellular and the extracellular matrix composition, which contributes facilitating tachy- and bradyarrhythmias.

• The incidence of AF in individuals $\ge$ 80 years is 12%, making AF arguably the most important arrhythmia in the elderly.

• In patients with AF <1 year, a rhythm control strategy should be considered over rate control, taking into consideration their baseline function.

• Smart Devices (wearables) are becoming important tools for the early diagnosis of AF, however more studies are needed to determine when to initiate anticoagulation.

• Leadless cardiac electronic devices are good for frail elderly patients and those at high risk for infection.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

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Additional information

Funding

This paper is not funded.