Atrial fibrillation in elderly and senile patients: features of antiarrhythmic and anticoagulant therapy

The prevalence of atrial fibrillation (AF) increases as the population ages. The incidence of complications associated with AF treatment also increases substantially in patients aged ≥75 years. According to Russian data, the prevalence of AF clearly increases with age, averaging 2.04% and reaching 9.6% in the 80-89 age group. Risk factors for cardiovascular disease associated with an increase in AF cases include overweight and obesity, alcohol consumption, obstructive sleep apnea, arterial hypertension, diabetes mellitus, a sedentary lifestyle, coronary heart disease, chronic heart failure, and chronic kidney disease. The effectiveness of catheter ablation may be less convincing compared with antiarrhythmic drug therapy for rhythm control in patients aged ≥75 years; however, it is considered a safe and effective treatment strategy for AF refractory to drug therapy. In addition to heart rate and rhythm control, the prevention of stroke and other cardiovascular complications is crucial for the management of AF. Given the high risk of cerebral stroke in individuals aged ≥75 years with AF, the benefit of stroke prevention with anticoagulants outweighs the risk of bleeding. Consequently, regardless of the presence of other risk factors, elderly and senile individuals with AF should receive oral anticoagulants. An interdisciplinary approach to decision-making is of great importance in the treatment of AF in elderly and senile people, who in most cases have comorbid pathology.