The Association of Age and Left Atrial Dysfunction in Patients with Atrial Fibrillation
Date
2025
Authors
Howie, J.O.
Dziano, J.K.
Ariyaratnam, J.P.
Abbas, M.
Kenny, G.T.
Evans, S.
Middeldorp, M.E.
Emami, M.
Sanders, P.
Elliott, A.D.
Editors
Advisors
Journal Title
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Type:
Journal article
Citation
Heart Rhythm, 2025; 1-9
Statement of Responsibility
Jackson O. Howie, Jenelle K. Dziano, Jonathan P. Ariyaratnam, Mohamed Abbas, Genevieve T. Kenny, Shaun Evans, Melissa E. Middeldorp, Mehrdad Emami, Prashanthan Sanders, Adrian D. Elliott
Conference Name
Abstract
Background: Heart failure with preserved ejection fraction is common in atrial fibrillation (AF), driven by an underlying left atrial (LA) cardiomyopathy. We hypothesize that advancing age is a key risk factor for the development of LA cardiomyopathy and heart failure with preserved ejection fraction in patients with AF. OBJECTIVE This study aimed to determine the impact of age on invasive and noninvasive measures of LA structure and function. Methods: Consecutive patients with symptomatic AF with preserved left ventricular (LV) function undergoing catheter ablation were enrolled. During ablation, invasive hemodynamic assessment was performed to quantify LA pressure and stiffness. Noninvasive assessment included LA reservoir strain and indexed volumes, LV global longitudinal strain, LV enddiastolic volume, and natriuretic peptides. Functional capacity was determined using cardiopulmonary exercise testing, and disease-specific patient-reported symptoms were assessed. Results were adjusted for common risk factors. Results: Of 125 patients, advancing age was associated with increased LA pressure (β = 0.08, P = .05) and stiffness (β = 0.10, P = .002). Patients older than 65 years had greater LA stiffness (P < .001), but no difference in LA pressure (P = .11). Noninvasive measures revealed reduced LA reservoir strain (β = –0.37, P < .001), increased LA minimum (β = 0.24, P < .001) and maximum volumes (β = 0.24, P = .007), reduced LV end-diastolic volume (β = –0.63, P = .005), and increased natriuretic peptides (β = 12.8, P = .01) with age. Age was associated with reduced peak oxygen consumption (β = –0.15, P = .02), but not AF (β = –0.01, P = .66) or heart failure symptoms (β = –0.13, P = .49). Conclusion: In patients with symptomatic AF, aging is associated with LA hemodynamic, structural, and functional impairments, suggestive of more advanced LA disease. These age-related changes were confirmed with exercise intolerance but not patient-reported symptoms
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Available online 10 July 2025.
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