What treatment options control atrial fibrillation in elderly?

Hello,

Welcome to icliniq.com.

I can understand your concern.

At 65, AFib (atrial fibrillation) is quite common, but needs attention because it can cause clots in the heart and lead to stroke. The palpitations and shortness of breath are classic. The primary goal is twofold: to maintain a controlled heart rate and reduce stroke risk with blood thinners.

Yes, there is a bleeding risk, but the benefit outweighs the risk if your stroke risk is moderate-to-high.

• The probable causes: Age-related atrial fibrosis, high blood pressure, possible thyroid problem, or other heart condition causing atrial enlargement.

• Investigations to be done:

1. ECG- electrocardiogram (already done).

2. Echocardiogram (for chamber size, pumping function, valves).

3. Thyroid profile.

4. Kidney and liver function tests (before starting NOACs- non-vitamin K antagonist oral anticoagulants).

5. Complete blood count.

6. 24-hour Holter if we need to see AFib burden.

• Differential diagnosis:

1. Atrial flutter.

2. Multifocal atrial tachycardia.

3. Frequent supraventricular ectopics mimicking AFib.

• Probable diagnosis: Non-valvular atrial fibrillation, symptomatic, new onset.

• Treatment plan:

1. Rate control: Beta blocker or calcium channel blocker to keep HR (heart rate) < 100 per minute.

2. Rhythm control: Electrical or drug cardioversion can be considered if duration < 48 hrs or after three to four weeks of anticoagulation.

3. Anticoagulation: Apixaban, Rivaroxaban, or Dabigatran preferred over Warfarin unless contraindicated.

4. Lifestyle: Control BP (blood pressure), avoid excess alcohol, and caffeine. Ablation is an option if episodes are frequent and drug treatment fails. Safe at 65 if heart function is good.

• Regarding follow-up:

1. Follow up after starting blood thinner to check for bleeding symptoms.

2. Kidney function is once a year.

3. Regular pulse and BP checks at home.

4. ECG once in a while to see the rhythm.

• Preventive measures:

1. Daily BP monitoring and maintenance.

I hope this information will help you.

Kindly follow up if you have more concerns.

Thank you.