The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme

Kenneth M. Madden, MSc, MD, FRCP(C), Assistant Professor, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, BC.

Syncope is a common presenting complaint in the older adult population. Unfortunately, cognitive issues and the fact that most falls are not witnessed in older adults can make the separation of falling and syncope quite difficult. In fact, about one third of older adults will have amnesia for faints, even if they are cognitively normal. A systemic approach can help separate cardiac from neurocardiovascular causes and avoid future mortality and morbidity.
Key words: syncope, aging, neurocardiovascular instability, Holter monitoring, tilt table testing.

Rajneesh Calton, MD, FACC, Division of Cardiac Electrophysiology, University Health Network, Toronto General Hospital, Toronto, ON.
Vijay Chauhan, MD, FRCPC, Division of Cardiac Electrophysiology, University Health Network, Toronto General Hospital, Toronto, ON.
Kumaraswamy Nanthakumar, MD, FRCPC, Division of Cardiac Electrophysiology, University Health Network, Toronto General Hospital, Toronto, ON.

Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance for which patients seek medical attention. AF has a heterogeneous clinical presentation, occurring in the presence or absence of detectable heart disease or related symptoms. Depending upon the duration and response to pharmacological and electrical cardioversion, AF can be classified as paroxysmal, persistent, or permanent. AF can be isolated or associated with other arrhythmias, often atrial flutter or atrial tachycardia. Minimum clinical evaluation of a patient with AF includes history, physical examination, and ECG documentation by at least single-lead ECG recording during the dysrhythmia. Additional investigation may include Holter monitoring, exercise testing, transesophageal echocardiography, and/or electrophysiological study.
Key words: arrhythmia, atrial fibrillation, Holter monitoring, atrial tachycardia.