Atrial Fibrillation in the Elderly: Who is at Risk?

Atrial fibrillation is recognized by all clinicians as an important arrhythmia. Its importance relates to the increased risk for cardioembolic stroke. The elderly are the most commonly affected. They have the highest incidence of atrial fibrillation and are the patients most vulnerable to the risk of stroke. It has been stated that the incidence of atrial fibrillation is only 0.2 per 1000 in patients aged 30-39. This figure increases to 39.0 per 1000 in patients 80-89 years old. Among patients seeking medical attention the prevalence can be even greater (Fig. 1). Atrial fibrillation's contribution to the risk of stroke increases with age. In patients 50-59 years of age it is estimated that 6.7% of strokes are associated with atrial fibrillation. In patients aged 80-89 this figure increases to 36.2%.1 This review will explore common etiologies leading to atrial fibrillation in the elderly. Important reversible causes will be emphasized. Some of the reasons this common arrhythmia is an especially important risk factor for cardioembolic stroke in this group will be illustrated.