Atrial fibrillation in the elderly

Atrial fibrillation (AF) is the most common arrhythmia in elderly population, with age being one of the most important factors involved in its pathogenesis. Conduction disturbances may be present on the surface electrocardiogram before AF onset in some patients. Once this arrhythmia is diagnosed, antithrombotic therapy is mandatory in most cases, as this is the only treatment that has demonstrated to improve survival. Age increases both the risk of thromboembolic and bleeding complications, while benefits from anticoagulant therapy outweigh that from bleeding in most scenarios, also in very elderly patients. However, elderly patients with AF are often undertreated. Non-vitamin K antagonist oral anticoagulants have emerged as an alternative to vitamin K antagonists, with significant less adverse events and better profile in terms of efficacy and safety. Other conditions related to age should be carefully evaluated in these patients (including frailty, comorbidity and polypharmacy) to ensure an individualized clinical and therapeutic approach.