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Cardiology Research and Practice
Volume 2011, Article ID 854205, 8 pages
http://dx.doi.org/10.4061/2011/854205
Review Article

Management of Patients with Atrial Fibrillation: Specific Considerations for the Old Age

Clinic of Cardiology, Cardiovascular Center, University Hospital of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland

Received 6 December 2010; Revised 28 April 2011; Accepted 13 June 2011

Academic Editor: Atul Verma

Copyright © 2011 Laurent M. Haegeli and Firat Duru. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Atrial fibrillation (AF) is the commonest of all sustained arrhythmias, and most of the patients seeking medical therapy are in the elderly age group. The management of these patients is particularly difficult due to associated comorbidities. Hypertension, congestive heart failure, left ventricular hypertrophy, and coronary artery disease are often present in the elderly patient population, and therefore, antiarrhythmic drugs often fail due to side effects, proarrhythmia, or poor rhythm control. Recently, radiofrequency catheter ablation has been widely performed as an efficient therapy for recurrent, drug-refractory AF. Nevertheless, patients at old age were underrepresented in prior AF ablation trials, and the current guidelines for catheter ablation of AF recommend a noninvasive approach in the elderly patient group due to the lack of clinical data supporting ablation therapy. However, study results of our group and others are suggesting that catheter ablation is a safe and effective treatment for patients over the age of 65 years with symptomatic, drug-refractory AF, and therefore, patients should not be precluded from catheter ablation only on the basis of age. This paper discusses the pharmacological (rhythm control, rate control, and anticoagulation) and catheter management of AF in the elderly population.