Influence of Age on Atrial Fibrillation Inducibility

The prevalence of AF is known to increase in the elderly. Some electrophysiological changes were reported in these patients, but the effects of age on AF inducibility and other electrophysiological signs associated with atrial vulnerability are unknown. The purpose of the study was to evaluate the effects of age on atrial vulnerability and AF induction. The study consisted of 734 patients (age 16-85 years, mean 61 +/- 15 years) without spontaneous AF who were admitted for electrophysiological study. Study was indicated for dizziness or ventricular tachyarrhythmia. Programmed atrial stimulation was systematically performed. One and two extrastimuli were delivered in sinus rhythm and atrial driven rhythms (600, 400 ms). Univariate and multivariate analysis of several clinical and electrophysiological data were performed. AF inducibility, defined as the induction of an AF lasting > 1 minute, was paradoxically and significantly decreased in elderly (> 70 years) patients compared to younger patients (< 70 years) (P < 0.01). AF inducibility was present in 40% of 62 patients < 40 years, 39% of 99 patients age 40-50 years, 37% of 130 patients age 50-60 years, 38% of 222 patients age 60-70 years, and only 28% of 221 patients > 70 years. There was no significant correlation with the sex, the presence of dizziness, the presence or not of an underlying heart disease, the left ventricular ejection fraction, and the presence of salvos of atrial premature beats on 24-hour Holter monitoring. There was a significant correlation with a longer atrial effective refractory period in the elderly (226 +/- 41 ms) than in younger patients (208 +/- 31 ms) (P < 0.001). Other electrophysiological parameters of atrial vulnerability did not change significantly. Increased atrial refractory period and age >70 years were independent factors of decreased AF inducibility. Programmed atrial stimulation should be interpreted cautiously before the age of 70 years. AF induction is facilitated by the presence of a short atrial refractory period in these patients. Surprisingly, AF inducibility decreases in patients > 70 years because their atrial refractory period increases. Therefore, increased AF prevalence in these patients should be explained by nonelectrophysiological causes.