The management of arrhythmias in elderly patients with
congestive heart failure, including
atrial fibrillation,
ventricular tachyarrhythmias, and
bradyarrhythmias, is described. Patients with
atrial fibrillation can be treated with rate control anticoagulation for
stroke prevention or by attempt at
cardioversion and maintenance of sinus rhythm. Elderly patients remaining in
atrial fibrillation benefit from anticoagulation provided that no
contraindication exists. In patients surviving malignant ventricular arrhythmias,
defibrillator implantation is beneficial in elderly patients with
heart failure. Prognosis and treatment of nonsustained arrhythmias depends on the presence of underlying cardiac abnormalities. In the healthy elderly population, treatment is not indicated. In patients with
coronary artery disease, decreased ejection fraction, and
nonsustained ventricular tachycardia, electrophysiology can further stratify risk, and
defibrillator implantation can improve survival if arrhythmias are induced. This benefit is as great in elderly patients as in younger patients. Symptomatic
bradycardias are increasingly common with advancing age. Symptoms are improved with pacing, with maximum benefit from physiologic rather than ventricular pacing. Although the elderly population poses a unique challenge when faced with arrhythmias, an active approach not only saves lives but also reduces morbidity.