Atrial fibrillation in the elderly

Atrial fibrillation is an arrhythmia with high prevalence in the elderly and it is frequently associated with comorbidities and anatomical and functional cardiac abnormalities, such as reduced ventricular distensibility. In elderly patients, this arrhythmia is often associated with specific clinical conditions such as cognitive impairment and/or dementia. The pathophysiological mechanism underlying this relationship is unknown, although some evidences support the hypothesis of microthromboembolism and/or cerebral hypoperfusion due to reduced cardiac output. If not properly managed, atrial fibrillation determines a significant impact in terms of morbidity and mortality, especially in the elderly. To ensure the best result in terms of outcome, the management of atrial fibrillation should be individualized according to patient characteristics and the underlying conditions, which are critical in the elderly. The potential risk of bleeding of anti-coagulant and the side effects of antiarrhythmic drugs should not be overlooked. The new oral anticoagulants can potentially meet this need by ensuring greater efficiency, reduction of cardiovascular morbidity and mortality, and improved safety profile, especially in old age. Finally, the refinement of ablation techniques for the treatment of atrial fibrillation will certainly find a great impact in old age.