Summary
This article summarizes the proceedings of the 4th Pivotal Research in Cardiology in the Elderly (PRICE) conference that was held on Nov. 11, 2006 in Chicago, IL. The meeting was co-sponsored by the Society of Geriatric Cardiology and the Heart Rhythm Society.
Michael W. Rich, MD, Washington University in St. Louis, and Anne B. Curtis, MD, FHRS, University of South Florida, served as co-chairs.
The primary objectives of the symposium were to provide an update on recent advances in the basic and clinical sciences relevant to the pathogenesis, diagnosis, and management of heart rhythm disorders in older adults, and to identify specific research priorities for further enhancing the understanding and treatment of heart rhythm disorders in the rapidly expanding elderly population.
The conference opened with an overview of the epidemiology of heart rhythm disorders in the elderly. This was followed by a series of six 1-hour sessions that addressed the following topics:
- effects of aging on cardiovascular electrophysiology
- sinoatrial dysfunction
- atrial fibrillation
- ventricular arrhythmias
- falls and syncope
- special populations and end-of-life issues
Each session consisted of 3 presentations by leading investigators followed by a discussion period chaired by an acknowledged expert in the field.
The program concluded with a lecture entitled “Future Directions in Electrophysiology: Focus on the Elderly” delivered by Dr. Douglas P. Zipes, MD, FACC.
Key Points
- The incidence, prevalence, and clinical impact of all forms of cardiac rhythm disorders and conduction disturbances increase markedly with age.
- Aging is associated with proteomic, cellular, physiologic, and structural changes in the myocardium and conduction system that predispose older persons to the development of supraventricular and ventricular rhythm disorders.
- Due to age-related changes in cardiovascular structure and function, coupled with the increasing prevalence of multiple co-morbid conditions in older adults, the results of studies conducted in predominantly middle-aged patients with heart rhythm disorders are not necessarily applicable to the elderly.
- Recent basic and clinical research studies have led to major advances in understanding both the electrophysiologic basis of heart rhythm disorders in older adults, as well as the diagnosis and treatment of these disorders in elderly patients.
- Despite these advances, there is a need for intensified research designed to develop more effective strategies for the prevention and management of heart rhythm disorders in the elderly population.
Key Areas for Future Investigation
- The role of the autonomic nervous system in arrhythmogenesis;
- The role of genetics and pharmacogenomics in diagnosis and treatment;
- Development of new drugs and new drug targets based in part on an improved understanding of the electrophysiology of the aging heart;
- Development of safer and more effective techniques for catheter ablation;
- Development of less invasive and less costly approaches to device therapy, such as leadless pacemakers and single-lead defibrillators;
- The role of stem cell therapies in the management of rhythm disorders in older adults.
American Journal of Geriatric Cardiology 2007;16(5):304-314
