Pacemaker therapy is indicated in patients with symptomatic bradycardia (syncope, presyncope, dyspnea, and exercise intolerance) correlated to sinus node dysfunction (pauses, persistent bradycardia, or chronotropic incompetence). In elderly patients, sinus node dysfunction is often associated with atrial tachyarrhythmias, including AF. Because of the frequent association of sinus node dysfunction with AF, VVI and VVIR pacing were once considered the preferred pacing modes. Recent studies suggest that atrial-based pacing in patients with sinus node dysfunction is beneficial for preventing progression of AF. (more…)

Aging is associated with progressive fibrosis of the sinoatrial node and AV conduction system, resulting in bradycardia, which may be further exacerbated by disease and medications, resulting in symptoms requiring permanent pacemaker implantation. More than 80% of pacemaker recipients in the United States are older than 65 years, and the median age is 75 years. As the population ages, it is anticipated that the number of older persons requiring permanent cardiac pacemakers, as well as the associated costs, will continue to rise. (more…)

In older patients without apparent cardiovascular disease, the number of cardiac myocytes declines, while residual myocytes enlarge. Concurrently, there is an increase in elastic and collagenous tissue in all parts of the interstitial matrix and conduction system with advancing age. (more…)

Atrial Fibrillation affects approximately 2.3 million people in the United States and is the most common rhythm disorder among U.S. patients hospitalized with a primary diagnosis of an cardiac arrhythmia. The median age of Atrial Fibrillation patients is 75 years; 84% are older than 65 years. Pooled data from studies of chronic Atrial Fibrillation in North America, Britain, and Iceland suggest a prevalence of 0.5% to 1% in the general population. (more…)

Growing older results in the various changes in the anatomy and physiology of human cardiovascular system. This affects in both healthy patients and patients with hypertension. The heart gets a less powerful pump, and needs to bring more to do the same job. (more…)

There are intrinsic changes in the cardiac pacemaker cells and the cardiac conduction system associated with aging, which increase the propensity of the elderly population to develop chronotropic incompetence, conduction block, and bradycardia overall. Moreover, the already-at-risk elderly population is more likely to receive and is more sensitive to a variety of cardiovascular agents that may cause further bradycardia through suppression of the pacemaker activity or AV block. (more…)