Reviewing the use of antiarrhythmic drugs in elderly patients with atrial fibrillation.

Introduction: Atrial fibrillation (AF) is the most common arrhythmia in elderly patients. Antiarrhythmic drugs (AADs) are often required for rate/rhythm control and to improve AF-related symptoms. There is limited evidence on the effectiveness and safety of AADs in elderly AF patients.

Areas covered: This narrative review focuses on the use of AADs in elderly AF patients, summarizing the different physiology, pharmacokinetics, and pharmacodynamics in the older age. Furthermore, the evidence from clinical studies on AADs pointing up data on safety and effectiveness in the elderly was summarized.

Expert opinion: Although AADs represent a cornerstone for symptom relief in patients with AF, these drugs did not show a clinical net benefit compared to rate control, with a potentially increased risk of complications and hospitalizations. Considering also the different pharmacokinetics and the concomitant comorbidities and treatments that characterize older patients, the administration of these drugs should be reserved for selected patients with a high burden of AF-related symptoms.