Management of the older person with ventricular arrhythmias.
OBJECTIVE
To review the prognosis and management of ventricular arrhythmias (VA) in persons with and without heart disease, with emphasis on older adults.


METHODS
A computer-assisted search of the English language literature (MEDLINE database) followed by a manual search of the bibliographies of pertinent articles.


METHODS
Studies on the prognosis and management of VA in persons with and without heart disease were screened for review. Studies in older persons and recent studies were emphasized.


METHODS
Pertinent data were extracted from the reviewed articles. Emphasis was placed on studies involving older persons. Relevant articles were reviewed in depth.


RESULTS
Available data on the prognosis and management of VA in persons with and without heart disease, with emphasis on studies in older persons, were summarized.


CONCLUSIONS
Ventricular arrhythmias in older persons without heart disease should not be treated with antiarrhythmic drugs, nor should Class I antiarrhythmic drugs 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 without contraindications to beta-blockers. Amiodarone should be reserved for life-threatening ventricular tachyarrhythmias in older persons who cannot tolerate or who do not respond to beta-blockers. Angiotensin-converting enzyme inhibitors should be used to treat older persons with heart failure, an anterior myocardial infarction, or a left ventricular ejection fraction < or = 40%. If older persons have life-threatening recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) resistant to antiarrhythmic drugs, invasive intervention should be performed. The automatic implantable cardioverter-defibrillator is recommended in older persons who have medically refractory sustained VT or VF.
Aronow
W S
WS
Hebrew Hospital Home, Bronx, New York 10475, USA.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000145:classification; D000075202:Contraindications; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D018579:Patient Selection; D015995:Prevalence; D011379:Prognosis; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D000638:Amiodarone