Managing atrial fibrillation in the very elderly patient: challenges and solutions

Abstract

Atrial fibrillation (AF) is the most common arrhythmia affecting elderly patients. Management and treatment of AF in this rapidly growing population of older patients involve a comprehensive assessment that includes comorbidities, functional, and social status. The cornerstone in therapy of AF is thromboembolic protection. Anticoagulation therapy has evolved, using conventional or newer medications. Percutaneous left atrial appendage closure is a new invasive procedure evolving as an alternative to systematic anticoagulation therapy. Rate or rhythm control leads to relief in symptoms, fewer hospitalizations, and an improvement in quality of life. Invasive methods, such as catheter ablation, are the new frontier of treatment in maintaining an even sinus rhythm in this particular population.

Characteristics of Cardiac Rhythm and Conduction Abnormalities Diagnosed in Mobile Emergency Units in Central Romania

“…The results of our study revealed that from the total study population, 92.78% of patients complaining of the The prevalence of AF is higher with age, and it is the most frequently encountered arrhythmia over the age of 65, mainly due to the aging process of the heart, which leads to myocardial fibrosis and remodeling. 24,25 Ventricular extrasystole or premature ventricular beats increase in prevalence with increasing age, in patients with or without heart disease, fact that could also be explained by the structural and electrical remodeling process of the myocardium that occurs with age. 3 When analyzing the study subjects by age groups, we found that older patients presented more frequent AF and ventricular extrasystole.…”

Cardiovascular KATP channels and advanced aging

“…Cardiac arrhythmias is a serious health concern, with atrial fibrillation (AF) the most common abnormal heart rhythm in the aged population ( 133 , 134 ). The molecular mechanisms of AF and ventricular tachycardia (VT) are diverse ( 135 ), with potential roles for altered ion channel activities and impaired intracellular Ca 2+ handling ( 136 ).…”

Cardiac Radiosurgery for the Treatment of Atrial Fibrillation

“…It is reported that 70% of individuals with AF have an age between 65 and 85 years [5]. While AF is not thought to be an immediately life-threatening morbidity, it is associated with an elevated risk of death [5].…”

“…It is reported that 70% of individuals with AF have an age between 65 and 85 years [5]. While AF is not thought to be an immediately life-threatening morbidity, it is associated with an elevated risk of death [5]. Symptomatic AF increases risk for stroke or thromboembolism, is associated with increased mortality, and can significantly affect quality of life [1].…”

“…Twenty-percent of all strokes are secondary to AF and it has been noted that strokes that result from AF are more disabling and have greater clinical significance than other forms of strokes [6]. From the Framingham cohort, it is found that the total mortality odds ratio is 1.5 and 1.9 for male and female patients with AF, respectively [5] [7]. The length of hospitalizations for patients with AF has been observed to be longer than the recorded times for other patients, and there are significant concerns with the decrease in quality of life that current treatment strategies mandate [5].…”