International Journal of Gerontology
Volume 2, Issue 1 , Pages 1-6, March 2008

Pharmacologic Therapy in the Elderly with Atrial Fibrillation

  • Shih-Huang Lee

      Affiliations

    • Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • Taipei Veterans General Hospital, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Shih-Huang Lee, Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, 95, Wen Chang Road, Shih Lin, Taipei, Taiwan
    • ,
  • Shih-Ann Chen

      Affiliations

    • Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • Taipei Veterans General Hospital, Taipei, Taiwan

Accepted 15 November 2007.

Article Outline

Summary 

Atrial fibrillation (AF) is the most common sustained arrhythmia, and its prevalence significantly increases with age. Morphologic changes in the atrial myocardium associated with AF may result from underlying cardiovascular disease and/or physiologic aging processes. Congestive heart failure, tachycardia-induced cardiomyopathy and thromboembolic events resulting from AF are more common in elderly patients. It is important to assess any comorbidity and potential triggers of AF before considering pharmacologic therapy for AF. Proper rate control should include control in response to exercise, together with an avoidance of bradycardias and symptomatic pauses in patients with AF. Digoxin, β-blockers and calcium channel blockers can all be effective in controlling ventricular rate in elderly patients with AF. In the elderly, amiodarone is probably the safest drug for short-term administration to exert chemical cardioversion, facilitate electrical cardioversion, and prevent recurrence of AF. Warfarin has been shown to be highly effective in preventing stroke in the elderly with AF; however, many studies also have documented underuse of warfarin, may be because of the increased risk of warfarin-induced hemorrhage in such patients. These findings have raised concerns regarding quality of care, physician adherence to guidelines, and translation of clinical trial results into real-world practice in anticoagulation therapy in the elderly with AF. [International Journal of Gerontology 2008; 2(1): 1–6]

Key Words:  antiarrhythmic drug , anticoagulation , atrial fibrillation

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PII: S1873-9598(08)70001-2

doi:10.1016/S1873-9598(08)70001-2

International Journal of Gerontology
Volume 2, Issue 1 , Pages 1-6, March 2008

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