Atrial Fibrillation in the Elderly

Atrial fibrillation is a common cardiac arrhythmia affecting up to 5% of people over the age of 65 years. The elderly are less well able to withstand the hemodynamic stress of new-onset and rapid atrial fibrillation. Advancing age is a predisposing factor for atrial fibrillation itself and for its complications. The main adverse outcomes caused by atrial fibrillation include peripheral embolic events, particularly stroke and left ventricular dysfunction. Sinus rhythm is of special importance in the elderly as it may be the main way to reduce the thromboembolic risks of atrial fibrillation. When sinus rhythm cannot be restored and maintained, control of heart rate by pharmacologic or other means has advantage in itself. The long-term benefits of aspirin and warfarin in patients with chronic nonvalvular atrial fibrillation have been demonstrated by recent trials. However, these benefits do not universally extend to patients above the age of 75 years, and thoughtful individualized antithrombotic treatment is needed for the elderly patient with atrial fibrillation.