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Review
. 2022 Jan 18;79(2):166-179.
doi: 10.1016/j.jacc.2021.10.037.

Management of Atrial Fibrillation in Patients 75 Years and Older: JACC State-of-the-Art Review

Annabelle Santos Volgman  1 , Gatha Nair  2 , Radmila Lyubarova  3 , Faisal M Merchant  4 , Pamela Mason  5 , Anne B Curtis  6 , Nanette K Wenger  4 , Neelum T Aggarwal  7 , James N Kirkpatrick  8 , Emelia J Benjamin  9
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Free article
Review

Management of Atrial Fibrillation in Patients 75 Years and Older: JACC State-of-the-Art Review

Annabelle Santos Volgman et al. J Am Coll Cardiol. .
Free article

Erratum in

  • Correction.
    [No authors listed] [No authors listed] J Am Coll Cardiol. 2022 May 17;79(19):1967. doi: 10.1016/j.jacc.2022.03.362. J Am Coll Cardiol. 2022. PMID: 35550695 No abstract available.

Abstract

The prevalence of atrial fibrillation (AF) is increasing as the population ages. AF treatment-related complications also increase markedly in older adults (defined as ≥75 years of age for this review). The older AF population has a high risk of stroke, bleeding, and death. Syncope and fall-related injuries are the most common reasons for nonprescription of oral anticoagulation (OAC), and are more common in older adults when OACs are used with antiarrhythmic drugs. Digoxin may be useful for rate control, but associations with increased mortality limit its use. Beyond rate and rhythm control considerations, stroke prophylaxis is critical to AF management, and the benefits of direct OACs, compared with warfarin, extend to older adults. Invasive procedures such as AF catheter ablation, pacemaker implantation/atrioventricular junction ablation, and left atrial appendage occlusion may be useful in appropriately selected cases. However, older adults have generally been under-represented in clinical trials.

Keywords: aged; aged 80 and over; antiarrhythmic drugs; catheter ablation; frailty; left atrial appendage occlusion; oral anticoagulation; strokes.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Volgman has received funding from the National Institutes of Health (IND Number 119127, NINR R01NR018443) and Novartis (CTQJ230A12001); has served as a Global Advisory Board Member for MSD/Bayer Virtual; has participated in the Bristol Myers Squibb Foundation Diverse Clinical Investigator Career Development Program (DCICDP); has served on the National Advisory Committee (NAC) for Janssen and on National Institutes of Health Clinical Trials; and has stock in Apple Inc. Dr Mason has served as a consultant for Medtronic, Boston Scientific, and Cook Medical. Dr Curtis has served on the advisory board of Abbott, Janssen Pharmaceuticals, Sanofi, and Milestone Pharmaceuticals; has received honoraria for speaking from Medtronic Inc and Zoll; and has served on the data monitoring board of Medtronic Inc. Dr Aggarwal has received funding from the National Institutes of Health (NIA, 1R01AG062637-01A1, 1R01AG054476-01A1, U24AG057437, P30AG010161, R01AG 056653, R01AG051635, and R01 AG062689-02). Dr Benjamin has received funding from the National Institutes of Health, National Heart, Lung, and Blood Institute (R01HL092577, 1R01HL128914, HL141434 01A1), National Institutes of Health (NIA R01AG066010, 1R01AG066914), and American Heart Association (AHA_18SFRN34110082). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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