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Treatment of ventricular arrhythmias in older adults
1Hebrew Hospital Home, Bronx, NY 10475, USA.
Insights
Ventricular arrhythmias (VA) in older adults without heart disease require no drug treatment. In those with heart disease, avoid Class I drugs; use beta-blockers or amiodarone for complex cases, and ACE inhibitors for heart failure-related VA.
Area of Science:
- Cardiology
- Geriatric Medicine
- Clinical Pharmacology
Background:
- Ventricular arrhythmias (VA) are a significant concern in older adults, both with and without underlying heart disease.
- Understanding the specific prognosis and management strategies for this demographic is crucial for effective clinical practice.
Purpose of the Study:
- To comprehensively review the current understanding of prognosis and management of ventricular arrhythmias (VA) in older individuals.
- To emphasize evidence-based treatment approaches for VA in the elderly, considering the presence or absence of heart disease.
Main Methods:
- A systematic literature search was conducted using MEDLINE, supplemented by manual bibliography reviews.
- Studies focusing on the prognosis and management of VA in older adults were prioritized and reviewed in depth.
Main Results:
- Antiarrhythmic drugs are generally not recommended for VA in older adults without heart disease.
- For older adults with heart disease, Class I antiarrhythmic drugs should be avoided; beta-blockers are recommended for complex VA, with amiodarone reserved for refractory cases.
- VA associated with heart failure warrants treatment with ACE inhibitors; invasive interventions like implantable cardioverter-defibrillators are indicated for life-threatening, refractory arrhythmias.
Conclusions:
- Treatment decisions for VA in older adults must be tailored to the presence of heart disease and arrhythmia severity.
- Non-pharmacological or less aggressive pharmacological approaches are often preferred in the elderly, prioritizing safety and efficacy.
- Guideline-directed medical therapy, including beta-blockers and ACE inhibitors, plays a key role, alongside consideration for device-based therapies in select cases.
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 people and recent studies were emphasized.
Data Extraction:
Pertinent data were extracted from the reviewed articles. Emphasis was on studies involving the older persons. Relevant articles were reviewed in depth.
Data Synthesis:
Available data about the prognosis and management of VA in persons with and without heart disease, with emphasis on studies involving older people, were summarized.
Conclusions:
VA in older persons without heart disease should not be treated with antiarrhythmic drugs. Class I antiarrhythmic drugs should not 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 if there are no contraindications to beta blocker therapy. The use of amiodarone in treating complex VA should be reserved for life-threatening ventricular tachyarrhythmias in older persons who cannot tolerate or who do not respond to beta blockers. VA associated with congestive heart failure should be treated with angiotensin converting enzyme inhibitors. If older patients have life-threatening recurrent ventricular tachycardia or ventricular fibrillation resistant to antiarrhythmic drugs, invasive intervention should be performed. The automatic implantable cardioverter-defibrillator is recommended in older patients who have medically refractory sustained ventricular tachycardia or ventricular fibrillation.