The Management of Ventricular Arrhythmias in Older Patients After CAST

Abstract

Asymptomatic nonsustained ventricular tachycardia and complex ventricular arrhythmias in elderly persons without heart disease should not be treated with antiarrhythmic drugs. Nonsustained ventricular tachycardia and complex ventricular arrhythmias in elderly persons are associated with an increased incidence of coronary events, primary ventricular fibrillation and sudden cardiac death, especially if abnormal left ventricular ejection fraction, left ventricular hypertrophy or silent ischaemia are present. beta-Blockers should be used in the treatment of elderly patients with ventricular tachycardia or complex ventricular arrhythmias associated with ischaemic or nonischaemic heart disease if there are no contraindications to beta-blocker therapy. I would reserve the use of amiodarone in the treatment of ventricular tachycardia or complex ventricular arrhythmias to life-threatening ventricular tachyarrhythmias in elderly patients who cannot tolerate or who do not respond to beta-blockers. Angiotensin converting enzyme (ACE) inhibitors should be used in treating elderly patients with ventricular tachycardia or complex ventricular arrhythmias associated with congestive heart failure. In patients with ventricular tachycardia or complex ventricular arrhythmias associated with asymptomatic left ventricular systolic dysfunction, I would use beta-blockers plus ACE inhibitors. If elderly patients have life-threatening, recurrent ventricular tachycardia or ventricular fibrillation resistant to antiarrhythmic drugs, invasive intervention is indicated. Until the results of prospective, randomised, clinical trials evaluating the automatic implantable cardioverter-defibrillator are available, I recommend using the automatic implantable cardioverter-defibrillator in elderly patients who have medically refractory sustained ventricular tachycardia or ventricular fibrillation.