Abstract

Human aging is a global issue with important implications for current and future incidence and prevalence of health conditions and disability. Cardiac arrhythmias, including atrial fibrillation, sudden cardiac death, and bradycardia requiring pacemaker placement, all increase exponentially after the age of 60. It is important to distinguish between the normal, physiological consequences of aging on cardiac electrophysiology and the abnormal, pathological alterations. The age-related cardiac changes include ventricular hypertrophy, senile amyloidosis, cardiac valvular degenerative changes and annular calcification, fibrous infiltration of the conduction system, and loss of natural pacemaker cells and these changes could have a profound effect on the development of arrhythmias. The age-related cardiac electrophysiological changes include up- and down-regulation of specific ion channel expression and intracellular Ca2+ overload which promote the development of cardiac arrhythmias. As ion channels are the substrates of antiarrhythmic drugs, it follows that the pharmacokinetics and pharmacodynamics of these drugs will also change with age. Aging alters the absorption, distribution, metabolism, and elimination of antiarrhythmic drugs, so liver and kidney function must be monitored to avoid potential adverse drug effects, and antiarrhythmic dosing may need to be adjusted for age. Elderly patients are also more susceptible to the side effects of many antiarrhythmics, including bradycardia, orthostatic hypotension, urinary retention, and falls. Moreover, the choice of antiarrhythmic drugs in the elderly patient is frequently complicated by the presence of co-morbid conditions and by polypharmacy, and the astute physician must pay careful attention to potential drug-drug interactions. Finally, it is important to remember that the use of antiarrhythmic drugs in elderly patients must be individualized and tailored to each patient's physiology, disease processes, and medication regimen.

Highlights

  • People constitute a larger segment of the population today than at any other time in history

  • The age-related cardiac electrophysiological changes include up- and down-regulation of specific ion channel expression and intracellular Ca2+ overload which promote the development of cardiac arrhythmias

  • As ion channels are the substrates of antiarrhythmic drugs, it follows that the pharmacokinetics and pharmacodynamics of these drugs will change with age

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Summary

Issues of global aging

People constitute a larger segment of the population today than at any other time in history. Published online: September 28, 2011 population dome (Figure 1). This trend applies to both male and females, in developing countries as well as in developed countries.[2] the large population in the developing world contributes significantly to the transformation in demographics. These trends in the global patterns of aging have important implications for the current and future incidence and prevalence of many health conditions. This review will focus on issues pertaining to the pharmacologic treatment of cardiac arrhythmias in the elderly population

Aging and cardiac arrhythmias
Changes in cardiac electrophysiology with aging
Changes in cardiac ion channels with aging
Changes in antiarrhythmic drug pharmacokinetics with age
Absorption
Distribution
Metabolism
Elimination
Changes in pharmacodynamics of antiarrhythmic drugs with aging
Issues with polypharmacy
Findings
Summary

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