Treatment of atrial fibrillation (AF) remains complex, especially in elderly patients. During a session chaired by S. Connolly (CA) and J.Y. Le Heuzey (FR), all the aspects of the treatment stategies in these patients were addressed, concerning stoke prevention (M. Ezekowitz, USA), rhythm control (H. Crijns, NL), rate control (F Cosio, ES), catheter ablation (K.H. Kuck, DE) and specific aspects of combined AF and heart failure (G. Naccarelli, USA).
To date, AF has become one of the major problems in arrhythmology, general cardiology and public health. The incidence of AF will rapidly increase in the coming decades, especially in elderly patients (see figure).
We still need new antithrombotic drugs, as VKA antagonists are effective but often poorly tolerated in the elderly. We still need new trials comparing rhythm and rate control strategies in peculiar populations. We still need new and better tolerated drugs for rhythm control and even for rate control as it is often necessary to make associations in order to obtain a good control, especially during exercise.
Concerning heart failure, we are waiting for the results of the AF – CHF trial comparing rhythm and rate control strategies. Many old patients have been enrolled in this study. Finally, the most challenging debate in this session concerned catheter ablation in this specific population.
K.H. Kuck reported his own results of AF ablation in elderly patients, showing that the results were inferior as compared to younger patients, but he concluded in a provocative way by saying that it was necessary to ablate patients when they are younger in order to avoid this increased risk !
Conclusion
Treatment of atrial fibrillation, especially in elderly patients, remains a challenging issue and is certainly one of the “last frontiers” in arrhythmology and even in cardiology ! The place of catheter ablation is still in debate, as the results of the technique are closely dependent on the experience of the ablation centres.
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European Society of Cardiology.