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Atrial Fibrillation in the Elderly

Facts and Management

  • Therapy In Practice
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Abstract

Although atrial fibrillation is not widely known by the general public, in developed countries it is the most common arrhythmia. The incidence increases markedly with advancing age. Thus, with the growing proportion of elderly individuals, atrial fibrillation will come to represent a significant medical and socioeconomic problem. The consequences of atrial fibrillation have the greatest impact. The risk of thromboembolism is well known; other outcomes of atrial fibrillation are less well recognised, such as its relationship with dementia, depression and death. Such consequences are responsible for diminished quality of life and considerable economic cost.

Atrial fibrillation is characterised by rapid and disorganised atrial activity, with a frequency between 300 and 600 beats/minute. The ventricles react irregularly, and may contract rapidly or slowly depending on the health of the conduction system. Clinical symptoms are varied, including palpitations, syncope, dizziness or embolic events. Atrial fibrillation may be paroxysmal, persistent or chronic, and a number of attacks are asymptomatic.

Suspicion or confirmation of atrial fibrillation necessitates investigation and, as far as possible, appropriate treatment of underlying causes such as hypertension, diabetes mellitus, hypoxia, hyperthyroidism and congestive heart failure. In the evaluation of atrial fibrillation, cardiac exploration is invaluable, including electrocardiogram (ECG) and echocardiography, with the aim of detecting cardiac abnormalities and directing management.

In elderly patients (arbitrarily defined as aged >75 years), the management of atrial fibrillation varies; it requires an individual approach, which largely depends on comorbid conditions, underlying cardiac disease, and patient and physician preferences. This management is essentially based on pharmacological treatment, but there are also nonpharmacological options. Two alternatives are possible: restoration and maintenance of sinus rhythm, or control of ventricular rate, leaving the atria in arrhythmia. Pharmacological options include antiarrhythmic drugs, such as class III agents, β-blockers and class IC agents. These drugs have some adverse effects, and careful monitoring is necessary. The nonpharmacological approach to atrial fibrillation includes external or internal direct-current cardioversion and new methods, such as catheter ablation of specific foci, an evolving science that has been shown to be successful in a very select group of atrial fibrillation patients.

Another serious challenge in the management of chronic atrial fibrillation in older individuals is the prevention of stroke, its primary outcome, by choosing an appropriate antithrombotic treatment (aspirin or warfarin). Several risk-stratification schemes have been validated and may be helpful to determine the best antithrombotic choice in individual patients.

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References

  1. Feinberg WM, Blackshear J, Laupacis A, et al. Prevalence, age distribution, and gender of patients with atrial fibrillation. Arch Intern Med 1995; 155: 469–73

    PubMed  CAS  Google Scholar 

  2. Braunwald E. Cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med 1997; 337: 1360–9

    PubMed  CAS  Google Scholar 

  3. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults. JAMA 2001; 285: 2370–5

    PubMed  CAS  Google Scholar 

  4. Majeed A, Moser K, Carroll K. Trends in the prevalence and management of atrial fibrillation in general practice in England and Wales, 1994–1998: analysis of data from the general practice research database. Heart 2001; 86(3): 284–8

    PubMed  CAS  Google Scholar 

  5. Dunn M, Alexander J, De Silva R, et al. Antithrombotic therapy in atrial fibrillation. Chest 1986; 89 Suppl. 2: 68S–74S

    PubMed  CAS  Google Scholar 

  6. Levy S. Epidemiology and classification of atrial fibrillation. J Cardiovasc Electrophysiol 1998; 9: S78–82

    PubMed  CAS  Google Scholar 

  7. Levy S. Nomenclature of atrial fibrillation or the tower of Babel. J Cardiovasc Electrophysiol 1998; 9: S83–5

    PubMed  CAS  Google Scholar 

  8. Gallagher MM, Camm AJ. Classification of atrial fibrillation. Pace 1997; 20: 1603–5

    PubMed  CAS  Google Scholar 

  9. Gallagher MM, Camm J. Classification of atrial fibrillation. Am J Cardiol 1998; 82: 18N–28N

    PubMed  CAS  Google Scholar 

  10. Haghi D, Schumacher B. Current management of symptomatic atrial fibrillation. Am J Cardiovasc Drugs 2001; 1(2): 127–39

    PubMed  CAS  Google Scholar 

  11. Psaty BM, Manolio TA, Kuller LH, et al. Incidence of and risk factors for atrial fibrillation in older adults. Circulation 1997; 96: 2455–61

    PubMed  CAS  Google Scholar 

  12. Furberg CD, Psaty BM, Manolio TA, et al. Prevalence of atrial fibrillation in elderly subjects: the Cardiovascular Health Study. Am J Cardiol 1994; 74: 236–41

    PubMed  CAS  Google Scholar 

  13. Godtfredsen J. Atrial fibrillation: course and prognosis — a follow-up study of 1212 cases. In: Kulbertus HE, Olsson SB, Schlepper M, editors. Atrial fibrillation. Mölndal: AB Hassle, 1982: 158–67

    Google Scholar 

  14. Manolio TA, Furberg CD, Rautaharju PM, et al. Cardiac arrhythmias on 24-h ambulatory electrocardiography in older women and men: the Cardiovascular Health Study. J Am Coll Cardiol 1994; 23(4): 916–25

    PubMed  CAS  Google Scholar 

  15. Lake FR, Thompson PL. Prevention of embolic complications in nonvalvular atrial fibrillation in the elderly. Drugs Aging 1991; 1(6): 458–66

    PubMed  CAS  Google Scholar 

  16. Vaziri M, Larson MG, Benjamin EJ, et al. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Study. Circulation 1994; 89: 724–30

    PubMed  CAS  Google Scholar 

  17. Karjalainen J, Kujala UM, Kaprio J, et al. Lone atrial fibrillation in vigorously exercising middle aged men: case-control study. BMJ 1998; 316: 1784–5

    PubMed  CAS  Google Scholar 

  18. Tsang TS, Barnes M, Bailey ME, et al. Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women. Mayo Clin Proc 2001; 76: 467–75

    PubMed  CAS  Google Scholar 

  19. Humphries KH, Kerr CR, Connolly SJ, et al. New-onset atrial fibrillation: sex differences in presentation, treatment, and outcome. Circulation 2001; 103: 2396–70

    Google Scholar 

  20. Benjamin EJ, Wolf PA, D’Agostino RA, et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998; 98: 946–52

    PubMed  CAS  Google Scholar 

  21. Claroni C, Cuenoud L, Bloch A. Clinical study to investigate the predictive parameters for the onset of atrial fibrillation in patients with essential hypertension. Am Heart J 2000; 139(5): 814–9

    Google Scholar 

  22. The AFFIRM Investigators. Baseline characteristics of patients with atrial fibrillation: the AFFIRM Study. Am Heart J 2002; 143: 991–1001

    Google Scholar 

  23. Wyse DG, Anderson JL, Antman EM, et al. Atrial fibrillation follow-up investigation of rhythm management: the AFFIRM Study design. Am J Cardiol 1997; 79: 1198–202

    Google Scholar 

  24. Levy S, Maarek M, Coumel P, et al. Characterization of different subsets of atrial fibrillation in general practice in France: the ALFA study. Circulation 1999; 99: 3028–35

    PubMed  CAS  Google Scholar 

  25. Bousser MG. Antithrombotic strategy in stroke. Thromb Haemost 2001; 86: 1–7

    PubMed  CAS  Google Scholar 

  26. Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: global burden of disease study. Lancet 1997; 349: 1269–76

    PubMed  CAS  Google Scholar 

  27. Skoog I, Palmeretz B, Nilsson L, et al. A population-based study of dementia in 85 years old. N Engl J Med 1993; 328: 153–8

    PubMed  CAS  Google Scholar 

  28. Caplan LR. Stroke treatment: promising but still struggling. JAMA 1998; 279: 1304–6

    PubMed  CAS  Google Scholar 

  29. Hart RG, Halperin JL. Atrial fibrillation and stroke: concepts and controversies. Stroke 2001; 32: 803–8

    PubMed  CAS  Google Scholar 

  30. Lamassa M, Di Carlo A, Pratucci G, et al. Characteristics, outcome, and care of stroke associated with atrial fibrillation in Europe. Stroke 2001; 32: 392–8

    PubMed  CAS  Google Scholar 

  31. Brittin M, Gustafsson C. Nonrheumatic atrial fibrillation as a risk factor for stroke. Stroke 1985; 16: 182–8

    Google Scholar 

  32. Jorgensen HS, Nakayama H, Reith J, et al. Acute stroke with atrial fibrillation: the Copenhagen Stroke Study. Stroke 1996; 27: 1765–9

    PubMed  CAS  Google Scholar 

  33. Candelise L, Pinardi G, Morabito A, Italian Acute Stroke Study Group, et al. Mortality in acute stroke with atrial fibrillation. Stroke 1991; 22: 169–74

    PubMed  CAS  Google Scholar 

  34. Wolf PA, Kannel WB, McGee DL, et al. Duration of atrial fibrillation and imminence of stroke: the Framingham Study. Stroke 1983; 14: 664–7

    PubMed  CAS  Google Scholar 

  35. Feinberg WM, Kronmal RA, Newman AB, et al. Stroke risk in an elderly population with atrial fibrillation. J Gen Intern Med 1999; 14: 56–9

    PubMed  CAS  Google Scholar 

  36. Biblo LA, Yuan Z, Quan KJ, et al. Risk of stroke in patients with atrial fibrillation. Am J Cardiol 2001; 87: 346–9

    PubMed  CAS  Google Scholar 

  37. Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases. Stroke 1990; 21: 637–76

    Google Scholar 

  38. Arboix A, Morcillo C, Garcia-Eroles L, et al. Different vascular risk factors profiles in ischemic stroke subtypes: a study from the “Sagrat Cor Hospital of Barcelona Stroke Registry”. Acta Neurol Scand 2000; 102: 264–70

    PubMed  CAS  Google Scholar 

  39. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor of stroke: the Framingham study. Stroke 1991; 22: 983–8

    PubMed  CAS  Google Scholar 

  40. Tanizaki Y, Kiyohara Y, Kato I, et al. Incidence and risk factor for subtypes of cerebral infarction in a general population: the Hisayama Study. Stroke 2000; 31: 2616–22

    PubMed  CAS  Google Scholar 

  41. Norrving B, Staaf G. Pure motor stroke from presumed lacunar infarct. Cerebrovasc Dis 1991; 1: 203–9

    Google Scholar 

  42. Gandolfo C, Capanetto C, Del Sotte M, et al. Risk factors in lacunar syndromes: a case-control study. Acta Neurol Scand 1988; 77: 22–6

    PubMed  CAS  Google Scholar 

  43. Arboix A, Garcia-Eroles L, Massons J, et al. Lacunar infarcts in patients aged 85 years and older. Acta Neurol Scand 2000; 101: 25–9

    PubMed  CAS  Google Scholar 

  44. Hajat C, Dundas R, Stewart JA, et al. Cerebrovascular risk factors and stroke subtypes: differences between ethnic groups. Stroke 2001; 32: 37–42

    PubMed  CAS  Google Scholar 

  45. Ott A, Breteler MM, De Bruyne MC, et al. Atrial fibrillation and dementia in a population-based study: the Rotterdam Study. Stroke 1997; 28: 316–21

    PubMed  CAS  Google Scholar 

  46. Kilander L, Andren B, Nyman H, et al. Atrial fibrillation is an independent determinant of low cognitive function. Stroke 1998; 29: 1816–20

    PubMed  CAS  Google Scholar 

  47. Sabatini T, Frisoni GB, Barbisoni P, et al. Atrial fibrillation and cognitive disorders In older people. J Am Geriatr Soc 2000; 48: 387–90

    PubMed  CAS  Google Scholar 

  48. Petersen P, Madsen EB, Brun B, et al. Silent cerebral infarction in chronic atrial fibrillation. Stroke 1987; 18: 1098–100

    PubMed  CAS  Google Scholar 

  49. Guidotti M, Tadeo G, Zanasi S, et al. Silent cerebral ischaemia in patients with chronic atrial fibrillation: a case-control study. Irish J Med 1990; 159: 96–7

    CAS  Google Scholar 

  50. Feinberg WM, Seeger JF, Carmody RF, et al. Epidemiologic features of asymptomatic cerebral infarction in patients with nonvalvular atrial fibrillation. Arch Intern Med 1990; 150: 2340–4

    PubMed  CAS  Google Scholar 

  51. Ezekowitz MD, James KE, Nazarian SM, et al. Silent cerebral infarction in patients with nonrheumatic atrial fibrillation. Circulation 1995; 92: 2178–82

    PubMed  CAS  Google Scholar 

  52. Jorgensen HS, Nakayama H, Raaschou HO, et al. Silent cerebral infarction in acute stroke patients: prevalence, location, risks factors, and clinical significance: the Copenhagen Stroke Study. Stroke 1994; 25: 97–104

    PubMed  CAS  Google Scholar 

  53. Loeb C, Gandolfo C, Bino G. Intellectual impairment and cerebral lesions in multiple cerebral infarcts: a clinical-computed tomography study. Stroke 1988; 18: 560–5

    Google Scholar 

  54. Breteler MM, Amerongen NM, Van Swieten JC, et al. Cognitive correlates of ventricular enlargement and cerebral white matter lesions on magnetic resonance imaging: the Rotterdam Study. Stroke 1994; 25: 1109–15

    PubMed  CAS  Google Scholar 

  55. Kirchner JT, Soderberg BB. Atrial fibrillation: clues to diagnosis and treatment. Hosp Med 1999; 35(3): 14–21

    Google Scholar 

  56. Krahn AD, Klein GJ, Kerr CR, et al. H. How useful is thyroid function testing in patients with recent onset atrial fibrillation? The Atrial Fibrillation Investigators. Arch Intern Med 1997; 157(12): 1385–90

    Google Scholar 

  57. Dorian P, Paquette M, Newman D, et al. Quality of life improves with treatment in the Canadian Trial of Atrial Fibrillation. Am Heart J 2002; 143: 984–90

    PubMed  Google Scholar 

  58. Mead GE, Elder AT, Faulkner S, et al. Cardioversion for atrial fibrillation: the views of consultant physicians, geriatricians and cardiologists. Age Ageing 1999; 28: 73–5

    PubMed  CAS  Google Scholar 

  59. Hohnloser SH, Kuck KH, Lilienthal J, et al. Rhythm or rate control in atrial fibrillation. Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial. Lancet 2000; 356: 1789–94

    PubMed  CAS  Google Scholar 

  60. Lawson-Matthew PJ, Ionescu A, McHugh P, et al. Evaluation of a protocol to select patients of all ages for cardioversion from atrial fibrillation. Age Ageing 1997; 26: 247–52

    PubMed  CAS  Google Scholar 

  61. English KM, Channer KS. Managing atrial fibrillation in elderly people. BMJ 1999; 318: 1088–9

    PubMed  CAS  Google Scholar 

  62. Gage BF, Fihn SD, White RH. Warfarin therapy for an octogenarian who has atrial fibrillation. Ann Intern Med 2001; 134: 465–74

    PubMed  CAS  Google Scholar 

  63. Carlsson J, Tebbe U, Rox J, et al. Cardioversion of atrial fibrillation in the elderly. Am J Cardiol 1996; 78: 1380–4

    PubMed  CAS  Google Scholar 

  64. Van Gelder IC, Crijns HJ, Van Gilst WH, et al. Prediction of uneventful cardioversion and maintenance of sinus rhythm from direct-current electrical cardioversion of chronic atrial fibrillation and flutter. Am J Cardiol 1991; 68: 41–6

    PubMed  Google Scholar 

  65. Maisel WH, Lee TH, Antman E, et al. Risk of electrical cardioversion in hospitalised patients with atrial fibrillation. Circulation 1995; 92 Suppl. 1: I–I40

    Google Scholar 

  66. Arnold AZ, Mick MJ, Mazurek RP, et al. Role of prophylactic anticoagulation for direct-current cardioversion in patients with atrial fibrillation or atrial flutter. J Am Coll Cardiol 1992; 19: 851–5

    PubMed  CAS  Google Scholar 

  67. Weinberg DM, Mancini GBJ. Anticoagulation for cardioversion of atrial fibrillation. Am J Cardiol 1989; 63: 745–6

    PubMed  CAS  Google Scholar 

  68. Bjerkelund CJ, Orning OM. The efficacy of anticoagulant therapy in preventing embolism related to DC electrical conversion of atrial fibrillation. Am J Cardiol 1969; 23: 208–16

    PubMed  CAS  Google Scholar 

  69. The Stroke Prevention in Atrial Fibrillation Investigators. Predictors of thromboembolism in atrial fibrillation, II: echocardiograph, features of patients at risk. Ann Intern Med 1992; 116: 6–12

    Google Scholar 

  70. Silverman DI, Manning WJ. Role of echocardiography in patients undergoing elective cardioversion of atrial fibrillation. Circulation 1998; 98: 479–86

    PubMed  CAS  Google Scholar 

  71. Seidl K, Rameken M, Drögemuller A, et al. Embolic events in patients with atrial fibrillation and effective anticoagulation: value of transesophageal echography to guide direct-current cardioversion. J Am Coll Cardiol 2002; 39: 1436–42

    PubMed  Google Scholar 

  72. Klein AL, Grimm RA, Murray RD, Assessment of Cardioversion Using Transesophageal Echocardiography Investigators, et al. Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation. N Engl J Med 2001; 344: 1411–20

    PubMed  CAS  Google Scholar 

  73. Levy S, Breithardt G, Campbell RW, et al. Atrial fibrillation: current knowledge and recommendations for management. Working group on Arrhythmias of the European Society of Cardiology. Eur Heart J 1998; 19(9): 1294–320

    PubMed  CAS  Google Scholar 

  74. Capucci A, Villani GQ, Aschieri D, et al. Oral amiodarone increases the efficacy of direct-current cardioversion in restoration of sinus rhythm in patients with chronic atrial fibrillation. Eur Heart J 2000; 21: 66–73

    PubMed  CAS  Google Scholar 

  75. Lundstrom T, Ryden L. Chronic atrial fibrillation: long term results of direct-current conversion. Acta Med Scand 1988; 223: 53–9

    PubMed  CAS  Google Scholar 

  76. Chun SA, Sager PT, Stevenson WG, et al. Long-term efficacy of amiodarone for the maintenance of normal sinus rhythm in patients with refractory atrial fibrillation or flutter. Am J Cardiol 1995; 76: 47–50

    PubMed  CAS  Google Scholar 

  77. Levy S, Lauribe P, Dolla E, et al. A randomized comparison of external and internal cardioversion of chronic atrial fibrillation. Circulation 1992; 86: 1415–20

    PubMed  CAS  Google Scholar 

  78. Borgeat A, Goy JJ, Maendly R, et al. Flecainide versus quinidine for conversion of atrial fibrillation to sinus rhythm. Am J Cardiol 1986; 58: 496–8

    PubMed  CAS  Google Scholar 

  79. Platia EV, Michelson EL, Portefield JK, et al. Esmolol versus verapamil in the acute treatment of atrial fibrillation or atrial flutter. Am J Cardiol 1989; 63: 925–9

    PubMed  CAS  Google Scholar 

  80. Kim CH, Daubert JP, Akiyama T. Antiarrhythmic agents in older patients. Drugs Aging 1994; 4(6): 462–9

    PubMed  CAS  Google Scholar 

  81. Vaughan Williams AM. A classification of antiarrhythmic action as reassessed after a decade of new drugs. J Clin Pharmacol 1984; 24: 129–47

    PubMed  CAS  Google Scholar 

  82. Nichol G, McAlister F, Pham B, et al. Meta-analysis of randomised controlled trials of the effectiveness of antiarrhythmic agents at promoting sinus rhythm in patients with atrial fibrillation. Heart 2002; 87: 535–43

    PubMed  CAS  Google Scholar 

  83. Alpert MA. Medical cardioversion of atrial fibrillation. Chest 2000; 117: 1529–31

    PubMed  CAS  Google Scholar 

  84. Peuhkurinen K, Niemelä M, Ylitalo A, et al. Effectiveness of amiodarone as a single oral dose for recent-onset atrial fibrillation. Am J Cardiol 2000; 85: 462–5

    PubMed  CAS  Google Scholar 

  85. Joseph AP, Ward MC. A prospective, randomized controlled trial comparing the efficacy and safety of sotalol, amiodarone, and digoxin for the reversion of new-onset atrial fibrillation. Ann Emerg Med 2000; 36(1): 1–9

    PubMed  CAS  Google Scholar 

  86. Fuster V, Rydén LE, Asinger RW, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2001; 38(4): 1231–66

    PubMed  CAS  Google Scholar 

  87. Roy D, Talajic M, Dorian P, et al. Amiodarone to prevent recurrence of atrial fibrillation. N Engl J Med 2000; 342: 913–20

    PubMed  CAS  Google Scholar 

  88. Lumer GB, Roy D, Talajic M, et al. Amiodarone reduces procedures and costs related to atrial fibrillation in a controlled clinical trial. Eur Heart J, 2002; 23: 1050–6

    PubMed  CAS  Google Scholar 

  89. Krahn A, Klein G, Skanes AC, et al. Amiodarone: pearl or peril? Eur Heart J, 2002; 23: 1001–2

    PubMed  CAS  Google Scholar 

  90. Singh S, Zoble RG, Yellen L, et al., for the Dofetilide Atrial Fibrillation Investigators. Efficacy and safety of oral dofetilide in converting to and maintaining sinus rhythm in patients with chronic atrial fibrillation or atrial flutter. Circulation 2000; 102: 2385–90

    PubMed  CAS  Google Scholar 

  91. Plewan A, Lehmann G, Ndrepepa G, et al. Maintenance of sinus rhythm after electrical cardioversion of persistent atrial fibrillation. Eur Heart J 2001; 22: 1504–10

    PubMed  CAS  Google Scholar 

  92. Falk RH. Atrial fibrillation. N Engl J Med 2001; 344: 1067–78

    PubMed  CAS  Google Scholar 

  93. Obel OA, Camm AJ. The use of drugs for cardioversion of recent onset atrial fibrillation and flutter: focus on Ibutilide. Drugs Aging 1998; 12(6): 461–75

    PubMed  CAS  Google Scholar 

  94. Kahn IA. Single oral loading dose of propafenone for pharmacological cardioversion of recent-onset atrial fibrillation. J Am Coll Cardiol 2001; 37: 542–7

    Google Scholar 

  95. Romano S, Fattore L, Toscano G, et al. Effectiveness and side effects of the treatment with propafenone and flecainide for recent-onset atrial fibrillation. Ital Heart J 2001; 2 (1 Suppl.): 41–5

    CAS  Google Scholar 

  96. Suttorp MJ, Kingma JH, Jessurun ER, et al. The value of class IC antiarrhythmic drugs for acute conversion of paroxysmal atrial fibrillation or flutter to sinus rhythm. J Am Coll Cardiol 1990; 16: 1722–7

    PubMed  CAS  Google Scholar 

  97. Benditt DG, Williams SH, Jin J, et al., for the d-l-Sotalol Atrial Fibrillation/Flutter Study Group. Maintenance of sinus rhythm with oral d, l-sotalol therapy in patients with symptomatic atrial fibrillation and/or atrial flutter. Am J Cardiol 1999; 84: 270–7

    PubMed  CAS  Google Scholar 

  98. Wuderman RL, Mooss AN, Mohiuddin SM, et al. Amiodarone vs sotalol as prophylaxis against atrial fibrillation/flutter after heart surgery. Chest 2002; 121: 1203–10

    Google Scholar 

  99. Brignole M, Menozzi C, Gianfranchi L, et al. Assessment of atrioventricular junction ablation and VVIR pacemaker versus pharmacological treatment in patients with heart failure and chronic atrial fibrillation. Circulation 1998; 98: 953–60

    PubMed  CAS  Google Scholar 

  100. Tsikouris JP, Craig DC. A review of class III antiarrhythmic agents for atrial fibrillation: maintenance of normal sinus rhythm. Pharmacotherapy 2001; 21(12): 1514–29

    PubMed  CAS  Google Scholar 

  101. Bellandi F, Simonetti I, Leoncini M, et al. Long-term efficacy and safety of propafenone and sotalol for the maintenance of sinus rhythm after conversion of recurrent symptomatic atrial fibrillation. Am J Cardiol 2001; 88: 640–5

    PubMed  CAS  Google Scholar 

  102. Donovan KD, Power BM, Hockings BE, et al. Intravenous flecainide versus amiodarone for recent onset atrial fibrillation. Am J Cardiol 1995; 75: 693–7

    PubMed  CAS  Google Scholar 

  103. Alboni P, Tomasi C, Menozzi C, et al. Efficacy and safety of out-of-hospital self-administered single-dose oral drug treatment in the management of infrequent, well-tolerated paroxysmal supraventricular tachycardia. J Am Coll Cardiol 2001; 37: 548–53

    PubMed  CAS  Google Scholar 

  104. Capucci A, Vallani G, Aschieri D, et al. Safety of oral propafenone in the cardioversion of recent atrial fibrillation to sinus rhythm: a prospective, parallel, placebo-controlled multicenter study. Int J Cardiol 1999; 68: 187–96

    PubMed  CAS  Google Scholar 

  105. Boriani G, Biffi M, Capucci A, et al. Oral propafenone to convert recent-onset atrial fibrillation in patients with and without underlying heart disease. Ann Intern Med 1997; 126: 621–5

    PubMed  CAS  Google Scholar 

  106. Boriani G, Biffi M, Capucci A, et al. Conversion of recent onset atrial fibrillation to sinus rhythm: effects of different drugs protocols. Pacing Clin Electrophysiol 1998; 21: 2470–4

    PubMed  CAS  Google Scholar 

  107. Vardas PE, Kochiadakis GE, Igoumenidis NE, et al. Amiodarone as a first-choice drug for restoring sinus rhythm in patients with atrial fibrillation: a randomised, controlled study. Chest 2000; 117: 1538–45

    PubMed  CAS  Google Scholar 

  108. Galve E, Rius T, Ballester R, et al. Intravenous amiodarone in treatment of recent onset atrial fibrillation: results of randomized, controlled study. J Am Coll Cardiol 1996; 27: 739–48

    Google Scholar 

  109. Kochiadakis GE, Igoumenidis NE, Fragiskos FI, et al. Amiodarone versus propafenone for conversion of chronic atrial fibrillation: results of a randomized, controlled study. J Am Coll Cardiol 1999; 33: 966–71

    PubMed  CAS  Google Scholar 

  110. Kochiadakis GE, Igoumenidis NE, Solomon MC, et al. Efficacy of amiodarone for the termination of persistent atrial fibrillation. Am J Coll Cardiol 1999; 83(1): 58–61

    CAS  Google Scholar 

  111. Ellenbogen KA, Stambler BS, Wood MA, et al. Efficacy of intravenous ibutilide for rapid termination of atrial fibrillation and flutter: a dose response study. J Am Coll Cardiol 1996; 28: 130–6

    PubMed  CAS  Google Scholar 

  112. Norgaard BL, Watchell K, Christensen PD, et al. Efficacy and safety of intravenously administered dofetilide in acute termination of atrial fibrillation and flutter: a multicenter, randomised, double-blind, placebo-controlled trial. Am Heart J 1999; 137: 1062–9

    PubMed  CAS  Google Scholar 

  113. Connolly SJ, Schnell D, Page RL, et al. Dose-response relations of azimilide in the management of symptomatic, recurrent, atrial fibrillation. Am J Cardiol 2001; 88: 974–9

    PubMed  CAS  Google Scholar 

  114. Kassotis J, Costeas C, Politzer M, et al. Rhythm management in atrial fibrillation: with a primary emphasis on pharmacological therapy, Part 3. Pacing Clin Electrophysiol 1998; 21(5): 1133–45

    PubMed  CAS  Google Scholar 

  115. Pritchett ELC. Management of atrial fibrillation. N Engl J Med 1992; 326: 1264–71

    PubMed  CAS  Google Scholar 

  116. Nattel S, Hadjis T, Talajic M. The treatment of atrial fibrillation: an evaluation of drug therapy, electrical modalities and therapeutic considerations. Drugs 1994; 48: 345–71

    PubMed  CAS  Google Scholar 

  117. Suttorp MJ, Kingma JH, Koomen EM, et al. Recurrence of paroxysmal atrial fibrillation or flutter after successful cardioversion in patients with normal left ventricular function. Am J Cardiol 1993; 71: 710–3

    PubMed  CAS  Google Scholar 

  118. Van Gelder IC, Crijns HJ, Tieleman RG, et al. Chronic atrial fibrillation: success of serial cardioversion therapy and safety of oral anticoagulation. Arch Intern Med 1996; 156: 2585–92

    PubMed  Google Scholar 

  119. Kochiadakis GE, Igoumenidis NE, Marketon ME, et al. Low dose amiodarone and sotalol in the treatment of recurrent, symptomatic atrial fibrillation: a comparative, placebo-controlled study. Heart 2000; 84: 251–7

    PubMed  CAS  Google Scholar 

  120. Murgatroyd FD, Gibson SM, Baiyan X, et al. Double-blind placebo-controlled trial of digoxin in symptomatic paroxysmal atrial fibrillation. Circulation 1999; 99: 2765–70

    PubMed  CAS  Google Scholar 

  121. Van Gelder IC, Brügemann J, Crijns HJ. Pharmacological management of arrhythmias in the elderly. Drugs Aging 1997; 11(2): 96–110

    PubMed  Google Scholar 

  122. Crijns HJ, Gosselink AT, Lie KT, PRODIS Study Group, et al. Propafenone versus disopyramide for maintenance of sinus rhythm after electrical conversion of chronic atrial fibrillation: a randomised, double-blind study. Cardiovasc Drugs Ther 1996; 10: 145–52

    PubMed  CAS  Google Scholar 

  123. Connoly SJ, Hoffert DL. Usefulness of propafenone for recurrent paroxysmal atrial fibrillation. Am J Cardiol 1989; 63: 817–9

    Google Scholar 

  124. Lee SH, Chen SA, Chiang CE, et al. Comparisons of oral propafenone and quinidine as an initial treatment option in patients with symptomatic paroxysmal atrial fibrillation: a double-blind, randomised trial. J Intern Med 1996; 239: 253–60

    PubMed  CAS  Google Scholar 

  125. Reimold SC, Cantillon CO, Friedman PL, et al. Propafenone versus sotalol for suppression of recurrent symptomatic atrial fibrillation. Am J Cardiol 1993; 71: 558–63

    PubMed  CAS  Google Scholar 

  126. Crijns HJ, Van Gelder IC, Van Gilst WH, et al. Serial antiarrhythmic drug treatment to maintain sinus rhythm after electrical cardioversion for chronic atrial fibrillation or atrial flutter. Am J Cardiol 1991; 68(4): 335–41

    PubMed  CAS  Google Scholar 

  127. Cox JL, Schuessler RB, D’Agostino HJ, et al. The surgical treatment of atrial fibrillation: development of a definitive surgical procedure. J Thorac Cardiovasc Surg 1991; 101: 569–83

    PubMed  CAS  Google Scholar 

  128. Ad N, Cox JL. Stroke prevention as an indication for the Maze procedure in the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg 2000; 12(1): 56–62

    PubMed  CAS  Google Scholar 

  129. Cox JL. Minimally-invasive maze procedure. Circulation 1999; 100 Suppl I: I–778

    Google Scholar 

  130. Haïssaguerre M, Jaïs P, Shah DC, et al. Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation 2000; 101: 1409–17

    PubMed  Google Scholar 

  131. Pappone C, Oreto G, Lamberi F, et al. Catheter ablation of paroxysmal atrial fibrillation using a 3D mapping system. Circulation 1999; 100: 1203–8

    PubMed  CAS  Google Scholar 

  132. Gillis AM, Wyse G, Connolly SJ, et al. Atrial pacing periablation for prevention of paroxysmal atrial fibrillation. Circulation 1999; 99: 2553–8

    PubMed  CAS  Google Scholar 

  133. Wood MA, Brown-Mahoney C, Kay N, et al. Clinical outcomes after ablation and pacing therapy for atrial fibrillation. Circulation 2000; 101: 1138–44

    PubMed  CAS  Google Scholar 

  134. Levy S, Ricard P, Lau CP, et al. Multicenter low energy transvenous atrial defibrillation (XAD) trial results in different subsets of atrial fibrillation. J Am Coll Cardiol 1997; 29: 750–5

    PubMed  CAS  Google Scholar 

  135. Wellens HJJ, Lau CP, Lüderitz B, et al. Atrioverter: an implantable device for the treatment of atrial fibrillation. Circulation 1998; 98: 1651–6

    PubMed  CAS  Google Scholar 

  136. Swerdlow CD, Schsls W, Dijkman B, et al. Detection of atrial fibrillation and flutter by a dual-chamber implantable cardioverter-defibrillator. Circulation 2000; 101: 878–85

    PubMed  CAS  Google Scholar 

  137. Atwood JE, Myers J, Sandhu S, et al. Optimal sampling interval to estimated heart rate at rest and during exercise in atrial fibrillation. Am J Cardiol 1989; 63: 45–8

    PubMed  CAS  Google Scholar 

  138. Blackshear JL, Lopecky SL, Litin SC, et al. Management of atrial fibrillation in adults: prevention of thromboembolism and symptomatic treatment. Mayo Clin Proc 1996; 71(2): 150–60

    PubMed  CAS  Google Scholar 

  139. Aronow S. Management of the older person with atrial fibrillation. J Am Geriatr Soc 1999; 47: 740–8

    PubMed  CAS  Google Scholar 

  140. Hanratty CG, McGlinchey P, Johnston GD, et al. Differential pharmacokinetics of digoxin in elderly patients. Drugs Aging 2000; 17(5): 353–62

    PubMed  CAS  Google Scholar 

  141. The Digitalis in Acute Atrial Fibrillation (DAAF) Trial Group. Intravenous digoxin in acute atrial fibrillation: results of a randomised, placebo-controlled multicenter trial in 239 patients. Eur Heart J 1997; 4: 649–54

    Google Scholar 

  142. Schreck DM, Rivera AR, Tricarico V. Emergency management of atrial fibrillation and flutter: intravenous diltiazem versus intravenous digoxin. Am Emerg Med 1997; 29(17): 135–40

    CAS  Google Scholar 

  143. Ellenbogen KA, Dias VC, Plumb VJ, et al. A placebo-controlled trial of continuous intravenous diltiazem infusion for 24-hour heart rate control during atrial fibrillation and atrial flutter: a multicenter study. J Am Coll Cardiol 1991; 18: 891–7

    PubMed  CAS  Google Scholar 

  144. Rinkenberger RL, Prystowsky EN, Heger JJ, et al. Effects of intravenous and chronic oral verapamil administration in patients with supraventricular tachyarrhythmias. Circulation 1980; 62: 996–1010

    PubMed  CAS  Google Scholar 

  145. Farshi R, Kistner D, Sarma JS, et al. Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimen. J Am Coll Cardiol 1999; 33(2): 304–10

    PubMed  CAS  Google Scholar 

  146. Clemo HF, Wood MA, Gilligan DM, et al. Intravenous amiodarone for acute heart control in the critically ill patient with atrial tachyarrhythmia. Am J Cardiol 1998; 81: 594–8

    PubMed  CAS  Google Scholar 

  147. Weinberg DM, Mancini GBJ. Anticoagulation for cardioversion of atrial fibrillation. Am J Cardiol 1989; 63: 745–6

    PubMed  CAS  Google Scholar 

  148. Albers GW, Dalen JE, Laupacis A, et al. Antithrombotic therapy in atrial fibrillation. Chest 2001; 119 (1 Suppl.): 194S–206S. Available from URL: http://www.chestjoumal.org

    PubMed  CAS  Google Scholar 

  149. Sebastian JL, Tresch DD. Use of oral anticoagulants in older patients. Drugs Aging 2000; 16(6): 409–35

    PubMed  CAS  Google Scholar 

  150. Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Arch Intern Med 1994; 154: 1449–57

    Google Scholar 

  151. Mead GE, Wardlaw JM, Lewis SC, et al. The influence of randomised trials on the use of anticoagulants for atrial fibrillation. Age Ageing 1999; 28: 441–6

    PubMed  CAS  Google Scholar 

  152. Monette J, Gurwitz JH, Rochon PA, et al. Physician attitudes concerning warfarin for stroke prevention in atrial fibrillation: results of a survey of long-term care practitioners. J Am Geriatr Soc 1997; 45: 1060–5

    PubMed  CAS  Google Scholar 

  153. White RH, McBurnie MAM, Manolio T, et al. Oral anticoagulation in patients with atrial fibrillation: adherence with guidelines in an elderly cohort. Am J Med 1999; 106: 165–71

    PubMed  CAS  Google Scholar 

  154. Go A, Hylek EM, Borowsky LH, et al. Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. Ann Intern Med 1999; 131(12): 927–34

    PubMed  CAS  Google Scholar 

  155. Stafford RS, Singer DE. Recent national patterns of warfarin use in atrial fibrillation. Circulation 1998; 97: 1231–3

    PubMed  CAS  Google Scholar 

  156. Petersen P, Boysen G, Godtfredsen J, et al. Placebo-controlled, randomized trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation: the Copenhagen AFASAK study. Lancet 1989; I: 175–9

    Google Scholar 

  157. The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. The effects of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. N Engl J Med 1990; 323: 505–11

    Google Scholar 

  158. EAFT (European Atrial Fibrillation Trial) Study Group. Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 1993; 342: 1255–62

    Google Scholar 

  159. Ezekowitz MD, Bridgers SL, James KE, et al., for the Veterans Affairs. Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators. Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. N Engl J Med 1992; 327: 1406–12

    PubMed  CAS  Google Scholar 

  160. Connolly SJ, Laupacis A, Gent M, et al. Canadian atrial fibrillation anticoagulation (CAFA) study. J Am Coll Cardiol 1991; 18: 349–55

    PubMed  CAS  Google Scholar 

  161. Stroke prevention in atrial fibrillation study: final results. Circulation 1991; 84: 527–39

  162. Fihn SD, Callahan CM, Martin DC, et al. The risk for and severity of bleeding complications in elderly patients treated with warfarin. Ann Intern Med 1996; 124: 970–9

    PubMed  CAS  Google Scholar 

  163. Palaretti G, Hirsh J, Legnani C, et al. Oral anticoagulation treatment in the elderly: a nested, prospective, case-controlled study. Arch Intern Med 2000; 160: 470–8

    Google Scholar 

  164. Pengo V, Legnani C, Noventa F, et al., on behalf of the Italian Study on Complications of Oral Anticoagulant Therapy (ISCOAT) Study Group. Oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and risk of bleeding: a multicenter inception cohort study. Thromb Haemost 2001; 85: 418–22

    PubMed  CAS  Google Scholar 

  165. The Stroke Prevention in Atrial Fibrillation Investigators. Bleeding during antithrombotic therapy in patients with atrial fibrillation. Arch Intern Med 1996; 156: 409–16

    Google Scholar 

  166. Marine JE, Goldhaber SZ. Controversies surrounding long-term anticoagulation of very elderly patients in atrial fibrillation. Chest 1998; 113: 1115–8

    PubMed  CAS  Google Scholar 

  167. Man-Son-Hing M, Nichol G, Lau A, et al. Choosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls. Arch Intern Med 1999; 159: 677–85

    PubMed  CAS  Google Scholar 

  168. Gedge J, Hampton KK, Channer KS, et al. A comparison of a low-dose warfarin induction regimen with the modified Fennerty regimen in elderly inpatients. Age Ageing 2000; 29: 31–4

    PubMed  CAS  Google Scholar 

  169. Chatap G, Chaïbi P, Giraud K, et al. Oral anticoagulation in older people: prospective evaluation of a new warfarin regimen and prediction of maintenance dose. Presse Med 2001; 30: 475–80

    PubMed  CAS  Google Scholar 

  170. Tait RC, Sefcick A. A warfarin induction regimen for outpatient anticoagulation in patients with atrial fibrillation. Br J Haematol 1998; 101: 450–4

    PubMed  CAS  Google Scholar 

  171. Hart RG, Boop BS, Anderson DC. Oral anticoagulants and intracranial hemorrhage: facts and hypotheses. Stroke 1995; 26: 1471–7

    PubMed  CAS  Google Scholar 

  172. SPAF III Writing Committee for the Stroke Prevention in Atrial Fibrillation Investigators. Patients with nonvalvular atrial fibrillation at low risk of stroke during treatment with aspirin: stroke prevention in atrial fibrillation III study. JAMA 1998; 279: 1273–7

    Google Scholar 

  173. Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001; 285: 2864–70

    PubMed  CAS  Google Scholar 

  174. Pearce LA, Hart RG, Halperin JL. Assessment of three schemes for stratifying stroke risk in patients with nonvalvular atrial fibrillation. Am J Med 2000; 109: 45–51

    PubMed  CAS  Google Scholar 

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Acknowledgements

The authors thank Mrs Isabelle Senegas-Gentilhomme for collaboration and collection of data. No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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  1. Department of Internal and Geriatric Medicine, Centre Hospitalier Emile Roux, Limeil-Brévannes Cedex, France

    Guy Chatap, Karine Giraud & Jean-Pierre Vincent

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  1. Guy Chatap
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  2. Karine Giraud
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  3. Jean-Pierre Vincent
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Correspondence to Guy Chatap.

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Chatap, G., Giraud, K. & Vincent, JP. Atrial Fibrillation in the Elderly. Drugs Aging 19, 819–846 (2002). https://doi.org/10.2165/00002512-200219110-00002

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