Pharmacologic therapies for atrial fibrillation

Pharmacologic therapy for atrial fibrillation may be used for acute cardioversion or ventricular rate control or for long-term therapy to maintain sinus rhythm or control ventricular rates in atrial fibrillation. Therapies must be tailored to elderly patients, with particular attention to structural heart disease, bradycardia, hypotension, and other comorbidities, including renal or hepatic insufficiency. Such considerations may dictate the use or avoidance of certain agents. Other important considerations for elderly patients include challenges associated with anticoagulation and maintaining therapeutic international normalized levels without risk of bleeding. When considering pharmacologic agents for elderly patients, it is also valuable to take into account socioeconomic issues, such as access to medications, adherence to complicated dosing schedules, and availability of appropriate clinical follow-up to assess therapeutic efficacy and adverse reactions to various agents. A carefully constructed therapeutic regimen can provide effective symptom control and atrial fibrillation management for elderly patients.