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Significance and Management of
Atrial Fibrillation in Elderly Patients
A
DGReview of :"Atrial Fibrillation in the Elderly"
Current Treatment Options in Cardiovascular Medicine
By Jill Taylor
Doctor's Guide , September 19,
2003
Atrial fibrillation (AF), the most common sustained arrhythmia clinically
encountered, and its associated morbidity and mortality, increases with
each decade of life, according to experts in a recently published
overview.
Patients with AF may be asymptomatic, or exhibit symptoms ranging from
palpitations, angina, heart failure, or stroke. Approximately 50% of
AF-associated strokes occur in patients above 75 years of age.
Furthermore, AF is the most frequent cause of disabling stroke in elderly
women.
Because AF markedly increases the risk of stroke and other embolic events,
aggressive treatment is warranted, say Jane Chen, M.D. and Michael W.
Rich, M.D., of the Washington University School of Medicine in St. Louis,
Missouri, United States. The researchers reviewed a variety of available
therapeutic options.
Goals for treatment in the elderly should primarily focus on symptom
alleviation and stroke prevention, while minimising potential toxic
effects of polypharmacy. Patients should be educated regarding awareness
of drug interactions, diet, and lifestyle factors.
The preferred method of treatment in asymptomatic patients is a
combination of rate control and anticoagulative therapy. Atrioventricular
(AV) nodal- blocking agents function to reduce symptoms by controlling
ventricular response rate. The inclusion of anticoagulation therapy should
be determined on an individual basis, balancing the risk of stroke against
the risk for major bleeding complications.
In patients with significant symptoms, antiarrhythmic therapy to maintain
sinus rhythm is used. Long-term anticoagulation is recommended in patients
on antiarrhythmic drugs, even for those in sinus rhythm.
Interventive procedures to restore sinus rhythm include electrical
cardioversion, AV nodal ablation, implantable devices, and radio frequency
ablation. Although electrical cardioversion is the most common treatment
method, AV nodal ablation combined with pacemaker implantation was
recently demonstrated as a safe and effective alternative.
The Cox-Maze surgical procedure is associated with complications in
elderly patients and is generally not recommended.
Emerging therapies include direct thrombin inhibition (ximelagatran),
antiarrhythmics (azimilide, pilsicaninide), and isolation of pulmonary
veins.
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© 2002 Global Action on Aging
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