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Senescence and Arrhythmogenesis

  • Mahek Mirza
  • Win-Kuang Shen
  • Arshad Jahangir
Chapter

Abstract

Cardiac arrhythmias are a major cause of morbidity and mortality, particularly in the elderly. With the rapidly changing population demographics, and increasing prevalence of cardiovascular disease, healthcare resource utilization for arrhythmia care is projected to rise exponentially. Aging is associated with electrophysiological alterations due to cardiac structural and functional remodeling, which combined with a blunted response to neurohumoral activation and hemodynamic responsiveness, results in increased propensity to brady and tachy-arrhythmias. These not only affect the quality of life but also contribute to the deterioration in myocardial function leading to heart failure, stroke and death.

Despite progress in the management of cardiovascular disease, arrhythmias in the elderly, continue to be a significant predicament. This is mainly due to limited understanding of the mechanisms and therapeutics directed against the underlying substrate that increases susceptibility of the heart to arrhythmogenesis and paucity of outcome studies in the older-elderly that limits specific practice guidelines in octo- and nona-genarians. Hence, further investigation is warranted to fully define the efficacy of anti-arrhythmic therapeutic modalities in the elderly that have proven to be effective in younger patients. This chapter summarizes the epidemiology, aging-associated cardiac structural and functional changes, basis for arrhythmogenesis, evaluation and management of elderly patients with ventricular tachyarrhythmias that increase predisposition to sudden death.

Keywords

Elderly Arrhythmia Sudden cardiac death Implantable cardioverter defibrillator Anti-arrhythmic drugs Ablation Aging 

Notes

Acknowledgement.

Drs. Jahangir and Mirza’s research effort was in part supported by the National Heart, Lung, and Blood Institute grants RO1 HL101240-02 and R01 HL089542-04.

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Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Center for Integrative Research on Cardiovascular Aging (CIRCA)Aurora University of Wisconsin Medical Group, Aurora Health CareMilwaukeeUSA
  2. 2.Division of Cardiovascular Diseases, Department of MedicineMayo Clinic College of Medicine, Mayo Clinic ArizonaPhoenixUSA
  3. 3.Center for Integrative Research on Cardiovascular Aging (CIRCA)Aurora University of Wisconsin Medical Group, Aurora Health CareMilwaukeeUSA

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