Key result
Treatment of ventricular arrhythmias in older adults should prioritize beta-blockers and ACE inhibitors, avoid Class I antiarrhythmics, and reserve ICDs for medically refractory cases.
Why the study?
How should ventricular arrhythmias be managed in older adults with and without heart disease?
How should ventricular arrhythmias be managed in older adults with and without heart disease?
This review outlines the management of ventricular arrhythmias in older adults, emphasizing the avoidance of Class I antiarrhythmics and the appropriate use of beta-blockers, amiodarone, and ICDs based on underlying heart disease.
Supports cautious management in older adults; leaves open need for dedicated prospective trials in geriatric populations.
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.
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Wilbert S. Aronow (1995) conducted a review in Ventricular arrhythmias. Antiarrhythmic drugs, beta blockers, amiodarone, ACE inhibitors, and ICDs was evaluated. Treatment of ventricular arrhythmias in older adults should prioritize beta-blockers and ACE inhibitors, avoid Class I antiarrhythmics, and reserve ICDs for medically refractory cases.
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