Supraventricular tachyarrhythmias in older persons

Atrial fibrillation (AF), the most common cardiac arrhythmia, is associated with a higher incidence of mortality, stroke, and coronary events than is sinus rhythm. AF with a rapid ventricular rate may cause a tachycardia-related cardiomyopathy. Indications for direct current cardioversion, drug treatment of AF, and nonpharmacologic therapies are discussed. Studies showing the results of ventricular rate control versus drug treatment to maintain sinus rhythm on clinical outcomes are also discussed. Patients with persistent or paroxysmal AF at high risk for stroke should be treated with long-term warfarin (with target international normalized ratio [INR] of 2.0 to 3.0) or with a direct oral anticoagulant (dabigatran, rivaroxaban, apixaban, or edoxaban). Patients with AF at low risk for stroke or with contraindications to anticoagulants can be treated with no antithrombotic therapy. Management of atrial flutter, paroxysmal supraventricular tachycardia, accelerated atrioventricular junctional rhythm, paroxysmal atrial tachycardia (PAT) with atrioventricular (AV) block, and multifocal atrial tachycardia is also discussed.