In critically ill patients and those with severely impaired LV systolic function, intravenous amiodarone can be used where excess heart rate is leading to haemodynamic instability. If the patient has a left ventricular ejection fraction (LVEF) <40%, then beta-blockers and/or digitalis are preferred over CCB, because CCB have negative inotropic effects. If high sympathetic tone is suspected as a reason for the high heart rate, then beta-blockers or non-dihydropyridine calcium channel blockers (CCB) are preferred over digoxin. The underlying causes of a high heart rate in new-onset AF could be acute infection, anaemia, endocrine imbalance, pulmonary thromboembolism, etc. Acute rate controlĪcute rate control refers to an acute slowing of the heart rate where haemodynamic stability is achieved.

The evidence concerning which is the best type of rate control and its intensity level is unclear. Rate control allows AF to persist, controlling the heart rate with medications that slow down the conduction through the atrioventricular (AV) node. Usually, this is sufficient to control the symptoms in symptomatic patients and it is also the treatment choice in asymptomatic patients. Rate control is the first-line therapy in elderly patients. Rate control therapy in atrial fibrillation The level of activity in the elderly is not the same as it is in young people medication tolerance can be lower and the number of comorbidities is higher. However, it should be borne in mind that the objectives of treatment are to be met for a number of years, not decades. As in other areas of medicine, age is no longer a limiting factor to different modalities of treatment which include all kinds of invasive techniques.

In addition to appropriate anticoagulation for stroke prevention (as a cornerstone in the therapy for AF), rate and rhythm control are two of the main long-term therapeutic strategies. Human aging produces changes in electrophysiological and electro-anatomical characteristics of the atrial myocardium.Īlthough AF itself cannot be considered as a cause of death, the presence of AF doubles all-cause mortality due to sudden death, heart failure or stroke. Īlongside the accumulation of different cardiovascular diseases and risk factors, aging itself is a condition predisposing to AF, characterised by myocardial fibrosis and atrial dilatation. Atrial fibrillation (AF) is the most frequent arrhythmia with increasing incidence in concordance with aging, reaching up to 10% prevalence in the population over 75 years.

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