Special Problems in Management of Atrial Fibrillation in the Elderly
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Atrial fibrillation is the commonest arrhythmia encountered in clinical practice, the prevalence of which increases with aging.
AF is the leading cause of cardiovascular morbidity and mortality among geriatric population and is the most common etiology for cardiogenic thromboembolism.
Management strategies in AF focus on prevention of thromboembolism and management of symptoms related to tachycardia.
Oral anticoagulation with warfarin and more recently non-vitamin K-dependent compounds is highly effective in preventing thromboembolism related to AF.
Rate control and rhythm control are the two major approaches for managing atrial fibrillation.
Rhythm control is preferred in symptomatic paroxysmal AF especially in young patients. Catheter ablation is evolving as a promising strategy for rhythm control in this subset over antiarrhythmic therapy which is limited by efficacy and toxicity of these drugs.
Prevalence of atrial fibrillation increases with aging.
Majority of AF in developed countries are from non-valvular heart disease.
AF causes significant morbidity and mortality, the major complication being strokes.
Older people have much to gain from oral anticoagulation, which is underutilized in this age group, even though treatment has to be individualized.
Rate control is acceptable in more persistent and less symptomatic patients. Stricter rate control over a more lenient approach is preferred in those with symptoms and ventricular dysfunction where as both approaches yield similar long-term results in rest of the patient population.
KeywordsAtrial Fibrillation (AF) Strict Rate Control Rhythm Control Catheter Ablation Oral Anticoagulation
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