TABLE 5.

Key Perspectives on Management of Arrhythmias in the Elderly

Because of age-related changes in pharmacodynamics and pharmacokinetics, elderly patients often require dose-adjustment of antiarrhythmic drugs and anticoagulants.

Very old patients with AF have an increased risk of stroke and bleeding, but there is a net benefit favoring the use of oral anticoagulants.

The procedural success and complication rates of catheter ablation of AF, SVT, AV junctional arrhythmia, and ventricular tachycardia in very elderly patients are similar to those in younger patients. However, the results of observational studies may be due, at least in part, to selection bias. Therefore, these procedures may be performed in the elderly with careful consideration of comorbidities, life expectancy, frailty, and patient preference.

The indications for implantable device therapy (ICDs, pacemakers, or CRT) are the same as in younger patients, and complication rates are comparable. The use of primary prevention ICDs in the very elderly population should take into account the goals of therapy, life expectancy, and competing comorbidities that would attenuate the survival benefit of ICDs.

There should be emphasis on shared decision-making and advanced care planning based on a candid discussion about the relative efficacy and possible harm from various treatments, competing comorbidities, frailty, patient preference, and advanced directives.

CRT = cardiac resynchronization therapy; SVT = supraventricular tachycardia; other abbreviations as in Table 4.