ARRHYTHMIA IN THE ELDERLY - CURRENT THERA PEUTIC APPROACH

Because the therapeutic margin of antiarrhythmic drugs is low in elder ly patients, the risk/benefit ratio should be carefully evaluated befo re initiation of treatment. Depressed contractility, arrhythmias, and depressed conduction are the main cardiac adverse effects of antiarrhy thmic agents. Cardiac function should be evaluated by echocardiography before initiation of treatment since adverse effects are more severe in patients with advanced cardiac dysfunction. A pretreatment Holter r ecording should also be performed routinely to look for subclinical co nduction disturbances. Only symptomatic rhythm disorders should be tre ated. Treatment of identified causes of rhythm disorders is the first step. A diagnostic and therapeutic strategy for the most common rhythm disorders in elderly patients (atrial fibrillation, sick sinus syndro me, and premature ventricular beats) is suggested.