Pharmacological management of arrhythmias in the elderly

The incidence of cardiac arrhythmia increases with advancing age, as does the prevalence of structural heart disease. Serious arrhythmias, such as sustained ventricular tachycardias, are uncommon in elderly patients, but nonsustained ventricular tachycardias and atrial fibrillation are relatively frequent. The first step in the treatment of supraventricular and ventricular arrhythmias is the identification of an underlying (cardiac) disease, which should be treated appropriately. Patients with supraventricular arrhythmias who do not have a severe underlying cardiac disease may be treated with antiarrhythmic drugs to prevent recurrences of the arrhythmia. In selected patients, radiofrequency catheter ablation may nowadays be the first-line therapeutic strategy. In elderly patients with underlying cardiac disease who are experiencing non-life-threatening arrhythmias, antiarrhythmic drugs are generally discouraged because of the risk of proarrhythmic effects or other adverse events. In patients experiencing life-threatening ventricular arrhythmias, beta-blockers may be the first-line therapy. If these drugs are not effective, or cause adverse effects, class III or class IC antiarrhythmic drugs may be used as alternatives. Radiofrequency ablation is only moderately effective for haemodynamically stable ventricular tachycardias occurring post-myocardial infarction, but may be an option in drug-refractory patients.