Atrial Fibrillation in the Elderly: A Review.

Atrial fibrillation is the most common cardiac arrhythmia in the elderly. It is associated with significant morbidity and mortality due to hemodynamic and cardioembolic complications. The incidence of stroke in elderly patients is 5 times higher than in patients in sinus rhythm. Atrial fibrillation should be actively treated in the elderly. Treatment should be directed toward the correction of reversible factors, control of ventricular response rate, restoration and maintenance of sinus rhythm, and prevention of cardioembolic events. Treatment of atrial fibrillation in the elderly should be individualized with careful regard for risk-benefit ratio

Cardiac Surgery in Patients At or Above 75 Years Old: Analysis of Perioperative and Long-term Outcome.

BACKGROUND: The peri-operative and long-term outcome of 211 consecutive patients at or above 75 years of age undergoing cardiac surgery between 1987-1990, was assessed. 79.6% of patients underwent CABG, 8.5% underwent both CABG and valvular surgery, 8.1% underwent only valvular surgery and 3.8% underwent other procedures. RESULTS: Survival curve analysis revealed no intra-operative deaths and a 30 day, 1,3, and 5 year overall survival rate of 93.3%, 89.2%, 77.8% and 64.6% respectively. 30.8% of patients had major peri-operative complications. Transient post-operative atrial fibrillation occurred in 47% of patients. There was a non-statistical trend towards increased risk of post-operative stroke in patients with transient post-operative atrial fibrillation. Early cardiothoracic re-operation was required in 8.5%. 91.9% of patients were followed up at a mean of 36.5Â+/-18.2 months post-operatively. 94.1% lived at home, 96.3% were ambulant, 96.3% were NYHA class I or II. Previously undetected malignancy was he cause of mortality in 10/45 (22%) patients who died after the thirtieth post-operative day, during the follow-up period. CONCLUSIONS: Chronologic age alone is not a contra-indication to cardiac surgery. Standard selection criteria with careful consideration of risk-benefit ratio, quality of life, presence of comorbid disease and health care costs should be factored in the decision process regarding cardiac surgery in the elderly. Particular attention should be paid to screening for malignancy and to management of transient post-operative atrial fibrillation