Antiarrhythmic therapy in elderly persons: a device-based approach

The management of ventricular arrhythmias in elderly persons has undergone a dramatic evolution over the past 10 years. Although life-threatening arrhythmias in elderly persons have been traditionally managed with a variety of pharmacologic agents, this population presents special challenges from pharmacokinetic and pharmacodynamic perspectives. Drug absorption, distribution, metabolism, and efficacy are often altered in elderly patients, resulting in a substantially narrowed therapeutic window. Nonpharmacologic therapy for ventricular arrhythmias has the advantage of not being subject to changes in metabolism, and due to recent technological advances in transvenous lead design as well as improved programming flexibility and reduction in device size, device-based therapy for malignant ventricular arrhythmias has become more attractive for use in elderly patients. Several recent studies have suggested that device-based therapy provides superior protection from malignant arrhythmias for both primary and secondary prevention indications. The majority of these studies suggest that the benefits of device-based therapy are conferred to patients independent of age. In addition, the complication rate of such therapy appears to be independent of age.