Atrial fibrillation in the elderly

Atrial fibrillation (AF) is prevalent in the elderly (affecting 5% of persons aged >or= 65 years and around 10% of those aged >or= 80 years old) and is associated with stroke, heart failure and poor quality of life. The symptoms of AF are palpitations, fatigue, reduced exercise capacity, dyspnea or dizziness. AF is associated with comorbidity, mainly hypertension in outpatients, and ischaemic heart disease and heart failure in hospitalized patients. Two therapeutic strategies are available to treat arrhythmia: rhythm control or frequency control. In many elderly patients with AF, frequency control is an effective option, particularly when there is heart failure, contraindications to antiarrhythmic agents or when cardioversion is not indicated. Anticoagulation is the main measure to reduce stroke risk. If anticoagulation is not appropriate for a patient, antiaggregants can be used, but the benefit is clearly lower than that provided by anticoagulation.