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EDITORIALS: Nicholas S Peters Catheter ablation for cardiac arrhythmias BMJ 2000; 321: 716-717 [Full text]

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Radiofrequency Ablation and the Elderly Patient

David Bourne   (27 September 2000)

Radiofrequency Ablation and the Elderly Patient 27 September 2000
David Bourne, SPR Geriatric Medicine Manchester Royal Infirmary Send response to journal: Re: Radiofrequency Ablation and the Elderly Patient	Dear Editor, Professor Peters in his editorial fails to justify his value-laden conclusion that 'clearly, the older patient with longstanding atrial fibrillation can be managed by controlling their ventricular rate and with anticoagulation treatment without need for input from a specialist'1. It is well recognised that the elderly are underrepresented in clinical trials of cardiovascular disease2 and are less likely to undergo appropriate cardiological investigation3. Importantly, the reason for valuing the life of the younger patient over that of the older one is not made explicit. Harris4 argues that what is valued by each of us is the rest of our lives, the duration of which is unknown. An anti-ageist argument is of particular relevance to catheter ablation, a procedure that is applicable to patients of all ages and considered by some to be first line therapy in selected elderly patients5. If catheter ablation is denied to the elderly on the basis of age then they are subject to the same injustice as if the procedure had been denied to the young on some equally spurious premise. 1. Peters NS. Catheter ablation for cardiac arrhythmias. BMJ 2000; 321: 716-7. 2. Bugeja G, Kumar A, Banerjee AK. Exclusion of elderly people from clinical research: a descriptive study of published reports. BMJ 1997; 315: 1059. 3. Bowling A, Ricciardi G, La Torre G, Boccia S, McKee D, McClay M, et al. The effect of age on the treatment and referral of older people with cardiovascular disease [abstract]. J Epidemiol Commun Health 1999; 53: 658. 4. Harris J. The value of life. London: Routledge, 1985. 5. Van Gelder IC, Brugemann J,Crijns HJ. Pharmacological management of arrhythmias in the elderly. Drugs Aging. 1997; 11: 96-110. Dr David Bourne SPR in Elderly Medicine Department of Elderly Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL davidr.bourne@doctors.org.uk