Is Avoidance of Cardioversion in the Elderly Warranted?

The prevalence of atrial fibrillation increases markedly with age. Older age (>70 years) has been considered by some as contraindication for cardioversion. We prospectively identified 183 patients with diagnosis of atrial fibrillation who were admitted to the Beth Israel Hospital between June 1990 and January 1994. The study group ranged from 29 to 96 years in age, with mean age of 72 ± 14 years. The clinically estimated duration of atrial fibrillation was known in 57% of patients and ranged from 1 to 913 days. Results: Cardioversion, either pharmacological or DC electrical was attempted in 115 (63%) of patients. Of the remainder, 17 spontaneously converted to sinus rhythm, 3 were found to have left atrial clot on transesophageal echocardiography prior to planned cardioversion and 4 died before cardioversion could be considered. The attending physician chose rate control alone in 44 patients. The age of patients who had cardioversion attempted was significantly younger (70.0 ± 14.2 years) as compared with the group in which cardioversion was not attempted (75.5 ± 12.8 years; P = 0.01). However, in the group who were successfully cardioverted pharmacologically (n = 34), the mean age was older (74.8 ± 15.2 years), as compared with those who failed pharmacological cardioversion (67.4 ± 13.2 years; P = 0.01). There was no age difference between those who responded to electrical cardioversion. In patients less than seventy years, the average duration of atrial fibrillation was 46 ± 75 days, while in those over seventy it was 45 ± 131 days (p = NS). Conclusion: Aged patients with atrial fibrillation are less likely to have cardioversion attempted, yet pharmacologic cardioversion is more likely to be successful. These dat suggest the presence of an inappropriate reluctance to attempt cardioversion in the elderly.