Arrhythmias

This chapter reviews arrhythmias in older individuals and their associated morbidity and mortality, emphasising the commonest rhythm disorder: atrial fibrillation (AF). Ageing of the heart is associated with the deposition of amyloid in the atrial myocardium, a gradual loss of the specialized pacemaker myocytes within the sinoatrial node, and the deposition of collagen and fibrous tissue in the specialized ventricular conduction tissue and throughout the myocardium. In reviewing 12-lead and 24-hour electrocardiogram findings in older patients, it can be difficult to distinguish whether purely ageing or pathological processes are responsible for apparent abnormalities. A slower ventricular rate is common and sometimes verges on symptomatic bradycardia. AF independently increases mortality by two-fold and is associated with stroke, other systemic thromboembolic disease, and heart failure and related morbidity, leading to poor quality of life. A number of non-pharmacological options have been explored to control and prevent AF. The most common supraventricular arrhythmia in older people is AF.