Management of arrhythmias

The management of arrhythmias in elderly patients with congestive heart fai lure, including atrial fibrillation, ventricular tachyarrhythmias, and brad yarrhythmias, is described. Patients with atrial fibrillation can be treate d with rate control anticoagulation for stroke prevention or by attempt at cardioversion and maintenance of sinus rhythm. Elderly patients remaining i n atrial fibrillation benefit from anticoagulation provided that no contrai ndication exists. In patients surviving malignant ventricular arrhythmias, defibrillator implantation is beneficial in elderly patients with heart fai lure. prognosis and treatment of nonsustained arrhythmias depends on the pr esence of underlying cardiac abnormalities. In the healthy elderly populati on, treatment is not indicated. In patients with coronary artery disease, d ecreased ejection fraction, and nonsustained ventricular tachycardia, elect rophysiology can further stratify risk, and defibrillator implantation can improve survival if arrhythmias are induced. This benefit is as great in el derly patients as in younger patients Symptomatic bradycardias are increasi ngly common with advancing age, Symptoms are improved with pacing, with, ma ximum benefit from physiologic rather than ventricular pacing. Although the elderly population poses a unique challenge when faced with arrhythmias, a n active approach not only saves lives but also reduces morbidity.