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Atrial Fibrillation in the Elderly.
MedLine Citation:
PMID:  12941204     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Atrial fibrillation (AF) is the most common sustained arrhythmia in adults, and its incidence and prevalence increase progressively with age. As a result, AF-associated morbidity and mortality increase with age. Therefore, because even asymptomatic AF markedly increases the risk of stroke and other embolic events, aggressive treatment is warranted in order to avoid the potentially devastating sequelae of this condition. Goals for the treatment of AF in the elderly population should primarily focus on alleviation of symptoms and prevention of strokes, while minimizing potential toxic effects of polypharmacy. Rate control should be optimized with atrioventricular (AV) nodal- blocking agents. The decision of anticoagulation should be individualized for each patient, balancing the risk of stroke against the risk for major bleeding complications. In elderly patients without symptoms, rate control and anticoagulation is the preferred method of treatment. Antiarrhythmic therapy to maintain sinus rhythm is generally reserved for patients with significant symptoms attributable to AF. However, simply maintaining sinus rhythm has not been proven to decrease stroke risk; therefore, long-term anticoagulation is recommended even in patients who are in sinus rhythm on antiarrhythmic drugs. AV nodal ablation with implantation of a pacemaker is a safe and excellent method of rate control for elderly patients who do not respond adequately to pharmacotherapy. Other invasive procedures, such as pulmonary vein isolation and Cox-Maze operations, are associated with high risks of complications in the elderly and are generally not recommended. Postoperative AF is common in the elderly population, and its development in high-risk patients should be anticipated and promptly treated to avoid potential hemodynamic compromise and prolonged hospitalization.
Authors:
Jane Chen; Michael W. Rich
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Publication Detail:
Type:  JOURNAL ARTICLE    
Journal Detail:
Title:  Current treatment options in cardiovascular medicine     Volume:  5     ISSN:  1534-3189     ISO Abbreviation:  Curr Treat Options Cardiovasc Med     Publication Date:  2003 Oct 
Date Detail:
Created Date:  2003-Aug-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815942     Medline TA:  Curr Treat Options Cardiovasc Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  355-367     Citation Subset:  -    
Affiliation:
Washington University School of Medicine, Cardiovascular Division, 660 S. Euclid Avenue, Campus Box 8086, St. Louis, MO 63110, USA. janechen@im.wustl.edu
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