Aging and arrhythmias: identifying early risk factors in healthy individuals

Abstract Background Atrial and ventricular ectopy are commonly observed in healthy individuals and are often considered benign. However, a higher burden of ectopy may suggest underlying cardiovascular pathology (1,2). Age-related electrical instability might be a precursor of heart disease (3). Identifying risk factors in asymptomatic individuals is essential for prompt intervention. Purpose To investigate the association between aging and ectopy, emphasizing the critical role of early identification of risk factors. Methods We screened 1,151 asymptomatic individuals without structural heart disease who underwent 24-hour Holter monitoring and exercise stress testing between 2010 and 2022. Participants were classified into high or low ectopy burden groups based on their median ectopy daily burden. Those exceeding the median and/or displaying complex arrhythmias such as atrial fibrillation (AF), supraventricular tachycardia (SVT), and non-sustained ventricular tachycardia (NSVT) were categorized as having high atrial or ventricular ectopic burden. Results The final cohort comprised 1,010 subjects (mean age 52 ± 7 years, 12% female). SVT and AF were detected in 320 (32%) and 38 (4%) subjects, respectively. NSVT was observed in 57 (6%) subjects. Univariate analysis revealed that high atrial ectopic burden (AEB) was associated with older age, male sex, lower fitness levels (assessed using METs), hypertension, and reduced eGFR. Similarly, high ventricular ectopic burden (VEB) was associated with older age and reduced eGFR; fitness levels did not confer a protective effect. Multivariable analysis confirmed that older age (OR: 1.08, 95% CI: 1.06–1.11, p 0.001) and lower fitness levels (OR: 1.52, 95% CI: 1.11–2.04, p = 0.008) were strong, independent risk factors for high AEB. In contrast, lower eGFR showed a weaker association with both high AEB (OR: 0.98, 95% CI: 0.97–0.99, p = 0.046) and VEB (OR: 0.98, 95% CI: 0.97–0.99, p = 0.034), suggesting a modest but consistent link. For VEB, older age persisted as a strong, independent risk factor (OR: 1.04, 95% CI: 1.02–1.06, p 0.001) (figure 1) . The proportional graphs show that while atrial arrhythmias exhibit a steady increasing trend, ventricular arrhythmias follow a non linear upward trend with some fluctuations (figure 2). Conclusion Age is a significant independent risk factor for both atrial and ventricular arrhythmias, while high fitness levels are a significant protective factor against AEB. These findings support age-based arrhythmia screening in preventive cardiology and highlight the protective role of fitness in reducing atrial arrhythmic risk.