COULD ACUTE MANAGEMENT OF AF IN ELDERLY BE IMPROVED?

Mar 28, 2019 Cardiotool Novità Fibrillazione Atriale Commenti disabilitati su COULD ACUTE MANAGEMENT OF AF IN ELDERLY BE IMPROVED?

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A Bonora, G Turcato, E Franchi*, A Dilda°, A Maccagnani – Emergency and *Cardiological Department, °Postgraduate School of Emergency Medicine, University of Verona

Acute management of atrial fibrillation (AF) in elderly is still debated. Although underlying structural heart disease often forces to rate control strategy, aging itself I many cases lead to a renouncing attitude. Therefore management of AF in elderly seems to have improved.

From January 2012 to December 2015 in the Emergency Department of University Hospital of Verona 1437 pts (676 males, 761 females, mean age 70 ys) were observed for recent-onset AF. Out of these, 601 pts (41.8%) were over 75 ys, with an expected prevalence of females and cardiovascular disease.

Rhythm control strategy was adopted to a significantly lesser extent in over 75 group compared to younger one (43.9% vs 69.4%, p < 0.05). Surprisingly, even in the former group timing > 48 h was the main contraindication (57.3%).

In 264 cases (96 males, 168 females, mean age 81 ys) a pharmacological cardioversion was attempted. As well as in younger group, onset < 24 h was predominant (89%) and palpitations the main symptom (76%). Amiodarone was the treatment of choice (69% of pts) for its supposed manegeability and safety.

We reported an early restoration of sinus rhythm in 61.3% of the cases, ranging from 54.4% of amiodarone to 85% of flecanide. After failure of pharmacological approach we resorted to an electrical cardioversion in 8 pts. Overall successful rate was thus 64.4%. We complained a very low complications rate (3%), without any relationship with treatment strategy.

Hospitalization rate was significantly higher in older group (55.3% vs 34%, p < 0.05), while the main indication remained the persistence of high-rate AF remained the main reason (35.6%), as well in the younger group.

Although elderly people are considered to be a fragile group, these results did not seem to support aging itself as a contraindication to “rhythm control” strategy. Therefore a larger use of class 1c antiarrhythmic drugs, when allowed by clinical conditions, or a most accurate indication to “rate control” therapy are expected to improve the acute management of AF and reduce the hospitalization rate even in elderly.

A 2-ys follow-up is carried out to compare “rhythm control” with “rate control” strategy regarding to wellness and disease-free period.

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