Ventricular arrhythmias in elderly patients

In evaluating and managing ventricular arrhythmias in elderly patients, the clinician must first decide which patients are appropriate candidates for therapy. Arrhythmias can be categorized as to their potential for causing sudden cardiac death as benign, potentially malignant, or malignant by considering their type and the underlying structural cardiac disease present. Factors that may aggravate the arrhythmias should be identified and corrected. The ventricular arrhythmias should be well characterized using ambulatory monitoring or electrophysiologic studies to gauge the efficacy of subsequent therapy. If pharmacologic therapy is to be initiated, the most appropriate antiarrhythmic drug should be chosen with consideration of potential efficacy, potential adverse cardiovascular and systemic side effects, pharmacokinetics, and drug interactions. In selected patients with malignant ventricular arrhythmias, the failure of antiarrhythmic medication may lead the clinician to consider nonpharmacologic therapy such as surgical endocardial resection or the automatic implantable cardioverter-defibrillator.