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Management of the older person with ventricular arrhythmias
1Hebrew Hospital Home, Bronx, New York 10475, USA.
Insights
Older adults with ventricular arrhythmias (VA) and no heart disease should not receive antiarrhythmic drugs. For those with heart disease, beta-blockers are preferred, with amiodarone reserved for severe cases.
Area of Science:
- Cardiology
- Geriatric Medicine
Background:
- Ventricular arrhythmias (VA) are a significant concern in older adults, both with and without underlying heart disease.
- Prognosis and management strategies for VA can differ substantially based on age and cardiac status.
Purpose of the Study:
- To comprehensively review the current understanding of prognosis and management of VA in older adults.
- To provide evidence-based recommendations for the treatment of VA in this specific demographic.
Main Methods:
- A systematic literature search of the MEDLINE database was conducted.
- Included studies focused on the prognosis and management of VA, with a specific emphasis on older populations and recent research.
Main Results:
- Class I antiarrhythmic drugs are not recommended for VA in older adults, regardless of heart disease presence.
- Beta-blockers are recommended for complex VA in older adults with ischemic or non-ischemic heart disease.
- Amiodarone is reserved for life-threatening VA unresponsive to beta-blockers.
- ACE inhibitors are indicated for older adults with heart failure or reduced ejection fraction.
- Invasive interventions and implantable cardioverter-defibrillators are recommended for refractory VT/VF.
Conclusions:
- Treatment decisions for VA in older adults must be individualized based on the presence and type of heart disease.
- Non-pharmacological and targeted pharmacological approaches are crucial for effective VA management in the elderly.
- Careful consideration of drug-specific risks and benefits is essential in this population.
Objective:
To review the prognosis and management of ventricular arrhythmias (VA) in persons with and without heart disease, with emphasis on older adults.
Data Sources:
A computer-assisted search of the English language literature (MEDLINE database) followed by a manual search of the bibliographies of pertinent articles.
Study Selection:
Studies on the prognosis and management of VA in persons with and without heart disease were screened for review. Studies in older persons and recent studies were emphasized.
Data Extraction:
Pertinent data were extracted from the reviewed articles. Emphasis was placed on studies involving older persons. Relevant articles were reviewed in depth.
Data Synthesis:
Available data on the prognosis and management of VA in persons with and without heart disease, with emphasis on studies in older persons, were summarized.
Conclusions:
Ventricular arrhythmias in older persons without heart disease should not be treated with antiarrhythmic drugs, nor should Class I antiarrhythmic drugs be used to treat VA in older persons with heart disease. Beta-blockers should be used to treat complex VA in older persons with ischemic or nonischemic heart disease without contraindications to beta-blockers. Amiodarone should be reserved for life-threatening ventricular tachyarrhythmias in older persons who cannot tolerate or who do not respond to beta-blockers. Angiotensin-converting enzyme inhibitors should be used to treat older persons with heart failure, an anterior myocardial infarction, or a left ventricular ejection fraction < or = 40%. If older persons have life-threatening recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) resistant to antiarrhythmic drugs, invasive intervention should be performed. The automatic implantable cardioverter-defibrillator is recommended in older persons who have medically refractory sustained VT or VF.