Actual treatment of atrial fibrillation in the elderly

Abstract

Atrial fibrillation (AFb) is a common arrhythmia in the elderly (17% of the cases) which can be precipitated by cardiac and non-cardiac factors. It can have characteristic symptoms (palpitations with rapid frequency) or it can borrow elements of low cardiac output syndrome (anginous pain, dyspnoea, fatigue, dizziness, syncope).The physical examination and ECG-cut the diagnosis. The goal of the treatment is the conversion to sinusal rhythm but the therapeutic decision should be made carefully in the elderly. The analysis of the therapeutic methods in patients aged> 65 years diagnosed with atrial fibrillation (AFb) regardless of its ethiology. We conducted a retrospective study on 704 patients (age> 65 years) hospitalized in the Geriatric Department of 4th Clinic of Internal MedicineNephrology Iasi between January 1- December 31 2009. The incidence of atrial fibrillation was followed in the study group, also the associated risk factors; trigger factors, indication of conversion to sinusal rhythm and response to the administration of anti-arrhythmic therapy. Out of 704 patients, 668 had cardiovascular damage (94%) and of these 224 patients had AFb (33.5%).From the group of patients with AFb, 156 were from rural areas, the majority being women (149 cases). The main risk factors incriminated were: hypertension (45%), dyslipidemia (38%), obesity (38%), and smoking (44%). Among the trigger factors are included: excessive physical effort and unexpected, intercurrent respiratory infections and ethanol consumption. From the types of AFb we note the predominance of fast AFb, followed by the recently installed AFb, paroxistical AFb and AFb with slow spontaneous frequency. In 54 cases was decided the chemical conversion in sinusal rhythm, with amiodarone in 44 cases (83%) and in 10 cases with Propafenone (17%). Sinusal rhythm was achieved in 48 of the 54 patients (88%). The attempt of conversion to sinusal rhythm was charged to all our patients regardless of age, but qualifying the standard criteria: normal sized cardiac cavity, EjF> 40%, no intracavitary thrombus, the AFb onset under 1 year. The conversion was carried out under protective anticoagulant therapy. The results were very good and the prevention of relapses was achieved with amiodarone, very well tolerated by patients.