[Treatment of cardiac arrhythmias in aged patients (author's transl)]

Area of Science:

• Cardiology
• Geriatrics

Context:

• Cardiac arrhythmias are prevalent in aged patients.
• Common causes include heart failure (coronary/hypertensive), hypersensitive carotis-sinus, digitalis intoxication, and hypokalemia.
• These conditions can lead to various tachyarrhythmias, bradyarrhythmias, and tachycardia-bradycardia syndrome.

Purpose:

• To outline the primary causes of cardiac arrhythmias in the elderly.
• To detail the spectrum of antiarrhythmic therapies available.
• To emphasize the importance of risk-benefit evaluation in antiarrhythmic treatment for older adults.

Summary:

• Common causes of cardiac arrhythmias in the elderly include heart failure, digitalis intoxication, and hypokalemia.
• Therapeutic strategies encompass heart failure management (digitalis, diuretics, nitrates), electrostimulation (pacemakers), digitalis withdrawal, potassium supplementation, and specific antiarrhythmic drugs.
• First-choice antiarrhythmic drugs are detailed for various arrhythmias, including beta-blockers for sinus tachycardia, ajmaline for supraventricular ectopic beats, verapamil for supraventricular tachycardia, lidoflazine/propafenone for atrial fibrillation, propafenone for ventricular ectopic beats, lidocaine for ventricular tachycardia, and electrodefibrillation for ventricular fibrillation.
• Bradyarrhythmias are managed with orciprenaline, atropine, and electrostimulation.
• Careful consideration of the advantage-risk ratio is crucial, especially in advanced age.
• Often, avoiding arrhythmias through judicious prescription of digitalis, diuretics, and laxatives is sufficient.

Impact:

• Provides a comprehensive overview of geriatric arrhythmias and their management.
• Guides clinicians in selecting appropriate antiarrhythmic therapies based on specific conditions and patient factors.
• Highlights the critical need for cautious drug prescription and risk assessment in elderly cardiac patients.