Abstract 2232: Effects of Aging on Type and Frequency of Rate and Rhythm Changes Before Onset of Paroxysmal Atrial Fibrillation
From anecdotes and small clinical studies, a shift from modulators to changes in the atrial electrophysiologic properties with aging has been reported as initiatiors of paroxysmal atrial fibrillation (pAF). However, detailed analyses of type and frequency of rate and rhythm changes before pAF have not yet been investigated in different age groups.
Methods and Results: From a total of 20.546 consecutive ambulatory 3-channel-24-hour-Holter-ECG-recordings, 715 episodes of pAF were identified in 350 patients [191 male, 159 female; 70.5 ± 11 (27–97) years]. To investigate age related differences of pAF onset scenarios, patients were devided into decades. The dominant portion of pAF onsets were preceded without rate or rhythm changes (sudden onset, n = 276; 38.6%), followed by atrial premature beat- (APB) related episodes [multiple APB, n = 134 (18.7%); short atrial runs; n = 43 (6.0%); single APB, n = 36 (5.0%); short-long-short sequence, n – 17 (2.4%); blocked APB, n = 2 (0.3%)]. Ventricular premature beats (VPB) were seen before pAF in 9.4% (n = 67), heart rate related onset scenarios in 24.3% (n = 140) [bradycardia, n = 97 (13.6%); tachycardia, n = 34 (4.8%); sudden rate drop, n = 9 (1.3%)]. There were no significant age related differences regarding pAF onset scenarios (Fig. 1⇓.). Only the incidence of sudden onset pAF was lower and the initiation of pAF after multiple APBs tendet to be higher in patients < 50 years.
Conclusion: In this first and largest study providing detailed analysis of spontaneous pAF the overall distribution of pAF onset scenarios is similar in all decades, suggesting that there is no shift of triggering or modulating mechanisms for pAF onset with normal aging.