Atrial fibrillation in the elderly

Atrial fibrillation (AF) is the commonest sustained arrhythmia affecting elderly people. It will become increasingly prevalent in Western societies, given the growing proportion of elderly people in these populations.>br> AF may lead to a variety of embolic phenomena, notably stroke. Furthermore, AF may complicate other conditions, such as hypertension and heart failure. AF is associated with an increased risk of death.
The management of AF can be a difficult problem, particularly in symptomatic, elderly patients. Results from recent large, multicentre clinical trials in sustained AF have demonstrated that a rate control strategy with conventional drugs, is at least as effective, and possibly superior, to rhythm control by chemical or electrical cardioversion over a three-year period. Whether these results can be extrapolated to longer time periods than the trials’ durations (approximately 3.5 years) is not known. Results from clinical trials of a new oral anticoagulant, ximelagatran, indicate that this agent is as good an anticoagulant as warfarin in sustained AF. Other results are awaited from on-going trials on the tolerability and side-effect profile of this drug. The possibility of an alternative anticoagulant which does not share warfarin’s need for routine monitoring of its anticoagulant effect, nor share warfarin’s potential for adverse interactions with other drugs, is very attractive, particularly in elderly patients.
In the longer term, radiofrequency ablation techniques might provide a more widely available, curative therapy, for elderly patients with AF.