Abstract
It is widely recognized that the elderly show an increased prevalence of cardiac arrhythmias. In this population, abnormalities in the conduction system can be the result of degenerative and fibrotic changes that occur with aging. Underlying disorders such as hypertension, diabetes mellitus, ischemic heart disease, congestive heart failure, and electrolyte imbalance may lead to the onset and exacerbation of arrhythmia. Cardiac arrhythmias, particularly in the elderly, are disorders of sinus node function (sinus bradycardia and sick sinus syndrome), abnormalities in the conduction system (AV block and bundle branch block), and supraventricular arrhythmia (supraventricular premature contraction and atrial fibrillation). The variety of symptoms, variation in individual constitution, and associated dementia reported can be attributed to the difficulties in eliciting clinical signs. In drug treatment, age-related changes of the pharmacokinetics and pharmacodynamics of antiarrhythmics have been evaluated extensively. Treatment of arrhythmia in elderly patients is complicated, and a clinical dilemma may often be encountered because of multiple comorbidities, decreased physiologic reserve, and polypharmacy. The incidence of atrial fibrillation (AF) increases with age. Cardiac embolic stroke is a major complication of AF. The CHADS2 score could be used to evaluate the risk of stroke in patients with AF. Oral anticoagulation, using either vitamin K anticoagulants or novel oral anticoagulants (NOACs), has consistently demonstrated a reduction in the risk of ischemic stroke. In terms of non-pharmacologic treatment, the indications for permanent pacemaker implantation, cardiac ablation, and cardioverter defibrillators in the elderly should be established without any age limit. However, careful consideration of invasive techniques is necessary. Because of the lower cardiac reserve, physiological pacing is useful in elderly patients.
