Management of atrial fibrillation in heart failure in the elderly.
In elderly patients, atrial fibrillation prevalence exceeds 10% and is commonly associated with heart failure rendering their management even more challenging. Therapies to be considered for heart failure related atrial fibrillation include appropriate treatment of underlying disease, prevention of thromboembolism, rate or rhythm control. The debate regarding rate versus rhythm control in the management of this group of patients has yet to be resolved. For old patients, the management requires an individual approach, which largely depends on comorbid conditions, underlying cardiac disease, and patient and physician preferences. Use of antiarrhythmic drug therapy for maintenance of sinus rhythm carries concerns of risk and limited efficacy. Catheter ablation for rhythm control is feasible for some patients, but further studies are needed to define the risks and benefits especially in older patients. Atrioventricular nodal ablation associated with pacing therapy is an effective non-pharmacological therapy in selected patients with medically refractory permanent high heart rate atrial fibrillation and heart failure. Several studies are ongoing and will provide more insight into the management of such patients.
Abi Nasr
Imad
I
Cardiology Department, University Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, UFR de médecine Paris-Ile-France-Ouest, Faculté de Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France. imad.abi-nasr@apr.aphp.fr
Mansencal
Nicolas
N
Dubourg
Olivier
O
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods; D019468:Disease Management; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D012307:Risk Factors
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents