The management of atrial fibrillation (AF) might be particularly cumbersome in complex older patients, barely represented in clinical trials. Rhythm control drugs often fail to provide sustained sinus rhythm (SR) and increase the risk of pro-arrhythmia and of extra-cardiac effects. Anticoagulants are poorly prescribed in the elderly [1], despite evidence of a good risk/benefit profile, and in paroxysmal AF, even if the risk for thrombo-embolic events is comparable to that of permanent AF and thus warrants the same type of management.
