Atrial fibrillation in the elderly

Adalet K.

TURK KARDIYOLOJI DERNEGI ARSIVI-ARCHIVES OF THE TURKISH SOCIETY OF CARDIOLOGY, cilt.45, ss.75-82, 2017 (ESCI) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 45
  • Basım Tarihi: 2017
  • Doi Numarası: 10.5543/tkda.2017.37863
  • Dergi Adı: TURK KARDIYOLOJI DERNEGI ARSIVI-ARCHIVES OF THE TURKISH SOCIETY OF CARDIOLOGY
  • Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, TR DİZİN (ULAKBİM)
  • Sayfa Sayıları: ss.75-82
  • Anahtar Kelimeler: Atrial fibrillation, ablation, stroke, elderly, CATHETER ABLATION, RHYTHM-CONTROL, ANTIARRHYTHMIC-DRUGS, RANDOMIZED-TRIALS, RADIOFREQUENCY ABLATION, ANTITHROMBOTIC THERAPY, MEDICARE BENEFICIARIES, ANTICOAGULANT-THERAPY, ORAL ANTICOAGULATION, STROKE PREVENTION
  • İstanbul Üniversitesi Adresli: Evet

Özet

The prevalence of atrial fibrillation increases dramatically with advancing age. Elderly adults with atrial fibrillation - even those with high bleeding risk-benefit from anticoagulation. The risk of ischemic stroke or systemic embolism was significantly lower with new direct oral anticoagulants (DOACs) than warfarin as was the risk of major bleeding and intracranial bleeding. Antiplatelet therapy should have a limited role for stroke prevention in elderly adults. Left atrial appendix occlusion may be a suitable alternative for those with contraindications to oral anticoagulants. For symptom management, it is likely that a strategy of lenient rate control is reasonable in elderly adults with atrial fibrillation. Rhythm control should be reserved for specific circumstances, in particular when symptoms cannot be managed using rate control. In appropriately selected elderly adults with symptomatic atrial fibrillation, catheter ablation may also be a useful strategy, with acceptable safety and efficacy based on limited data. A rhythm control strategy should not preclude anticoagulation.