Age in aortic disease: The path towards atrial fibrillation

Aging induces structural remodeling, altering atrial electrogram morphology. Over time, structural and consequently electrical remodeling creates a substrate for atrial fibrillation. In structural heart disease, age-induced remodeling comes on top of a pre-existing degree of structural remodeling due to pressure or volume overload Investigate the severity of age-related electrical remodeling in patients undergoing surgery for structural heart disease by utilizing a high resolution epicardial mapping approach. Five seconds of sinus rhythm were recorded intraoperatively at the right atrium (RA), Bachmann’s bundle (BB), the left atrium, and the pulmonary vein area. Potential voltage, low-voltage area (LVA) and conduction velocity (CV) were assessed in all regions. 104 patients were included (62,5% male, age: 26-84 years) and categorized in three age groups: young-age (age < 60 years, n=40), middle-age (age 60 to 71 years, n=33), or old-age (age ≥72 years, n=31) group. Compared to the young-age group, the old-age group had 1) lower median potential voltages at RA (4.65 [3.53-5.62]mV versus 5.94 [4.86-6.79]mV, p=0.001) and 2) lower CV at RA (87.86 [82.53-96.67]cm/s versus 94.81 [90.14-98.59]cm/s, p=0.016) and BB (83.38 [67.72-94.96]cm/s versus 98.84 [86.58-102.90]cm/s, p=0.005). Age-related electrophysiological changes in patients with structural heart disease include reduction in atrial potential voltages and slowing of CV. These changes were less pronounced in the middle-age group. This indicates that electrical remodeling is a combination of both the underlying heart disease and the aging process. However, the less pronounced changes in the middle-age group may reflect a more gradual progression of age-related remodeling.