Atrial Fibrillation in the Elderly: Challenges and Treatment Approaches

When it comes to the most common type of abnormal heart rhythm condition in older adults, atrial fibrillation comes in the first place. This condition causes irregular heart rhythm in your heart’s upper chambers called atria. Not only does it cause fatigue, heart palpitations, and trouble breathing, but it can also lead to stroke and heart failure if left untreated. Luckily, there are many treatment options available to treat this condition. Learn about the challenges of Atrial fibrillation in the elderly and treatment options in the article. Get a consultation with the best cardiologists in Brooklyn.



Challenges with atrial fibrillation in the elderly

Atrial Fibrillation commonly occurs in the elderly which affects their heart’s electrical system. As your electrical impulses turn chaotic, it causes an irregular and rapid heartbeat. This happens because when you have atrial fibrillation, your SA node does not direct your heart’s electrical rhythm; instead, many different impulses rapidly fire at the same time, which causes a fast chaotic rhythm in your atria.

As a result, your atria are not able to contract or pump blood effectively into your ventricles. Your ventricles contract irregularly, and it leads to a rapidly irregular heartbeat. It’s just like in the middle of a concert if two more conductors walk onto the stage and start waving their batons, the musicians would not know who they should follow and what to do. The music would lose its rhythm and harmony. Luckily, there are many ways to bring back your heart’s rhythm and harmony if you have Afib. But first, you should notice the signs and visit your doctor to get a proper evaluation.

AFib can increase the risk of stroke in older adults. Afib has been associated with around 25% of all stroke cases over the age of 40 years, the risk is 5 times higher in individuals with AFib than without it. It also leads to other complications such as heart failure. Some research also found that AFib may lead to cognitive decline.

A 2023 study found that AFib may be linked with a greater 45% risk of mild cognitive impairment. The study states it could partly happen due to cardiovascular risk factors and other conditions linked with AFib.


Treatment options

Treatment for AFib in older people is classified into 3 categories:

  1. Rate control:

This is the most common treatment option used to treat older adults. In the rate control approach, the doctor focuses on managing the heart rate to a target range of 80 to 110 beats per minute (BPM) at rest to improve symptoms such as palpitations and shortness of breath.

To manage your heart rate, doctors may prescribe medications such as beta-blockers or calcium channel blockers to reduce heart rate and regulate rhythm in older adults with AFib.

There are three classification categories for treating AFib in older people.


  1. Rhythm control:

The goal of rhythm control is to restore and maintain a person’s typical heart rhythm. However, studies also found that higher rates of adverse events in older adults are also possible with antiarrhythmic drugs. These drugs are immensely helpful for older adults who have AFib without symptoms. Rhythm control is generally less effective in longstanding AFib, which is more likely the case with older adults.

In some cases, the doctor may prescribe antiarrhythmic medications such as amiodarone or interventions such as cardioversion or catheter ablation.


  1. Prevention of thromboembolic events:

Older adults with AFib are more at risk of stroke due to blood clots forming in the atria of the heart. To prevent that, doctors often prescribe blood thinners, such as warfarin, and oral anticoagulants, such as apixaban or dabigatran, to prevent blood clots and reduce stroke risk.

If medications don’t work in the elderly, doctors may recommend a procedure or surgery.

  • Electrical cardioversion: In this procedure, low-energy shocks are given to the chest to reset heart rhythm, however, it is only used as a temporary solution.
  • Pulmonary vein ablation: In this procedure, the doctor uses a catheter to deliver energy outside or around the pulmonary veins to ensure that your body responds better to your Afib medications. In some cases, you may not even need medications in the long term.
  • Permanent pacemaker: It is a device attached to your skin that gives an electric shock if you have a slow heart rate. Usually, recommended if you have another arrhythmia in addition to Afib.
  • Left atrial appendage closure: This procedure is used to reduce the risk of blood clots and stroke.
  • MAZE procedure: In this procedure, a doctor creates scar tissue to help your heart’s electrical impulses travel in the right path. It has a high success rate, and doctors recommend this procedure if you have severe AFib symptoms and a history of stroke and blood clots.


Many procedures are non-invasive, and newer treatment options and technologies are constantly developing. Consult with your doctor about the options that are best for you.


Atrial Fibrillation is a complex heart condition that is often severe and challenging in older adults as they are more prone to complications like cognitive decline and heart failure. However, there are many treatment options available to treat them and manage their condition. With proper treatment and lifestyle changes, people can live a better life even with atrial fibrillation.


Need help with atrial fibrillation, visit our cardiology clinic in Brooklyn today for proper diagnosis and treatment options. If you need tips on how to keep your heart healthy, call us on +1(347) 384-5690. The Cardiologists at Doral Health & Wellness consistently have outstanding patient satisfaction ratings. The professionals at Heart Specialist Brooklyn are able to greatly improve their patient’s health and quality of life because of their vast training and experience. New Yorkers can get the greatest medical, surgical, and cardiovascular care at Doral Health & Wellness Brooklyn. Visit us at 1797 Pitkin Avenue, Brooklyn, NY 11212.