Special Problems in Management of Atrial Fibrillation in the Elderly

  • Syamkumar M. Divakara MenonEmail author


  • 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.


Atrial Fibrillation (AF) Strict Rate Control Rhythm Control Catheter Ablation Oral Anticoagulation 
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Copyright information

© The Editor(s)  2018

Authors and Affiliations

  1. 1.Cardiology, Cardiac Electrophysiology, Health EducationMcMaster UniversityHamiltonCanada

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