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Antiarrhythmic agents in older patients. Current state of knowledge.

Publication ,  Journal Article
Kim, CH; Daubert, JP; Akiyama, T
Published in: Drugs Aging
June 1994

The treatment of ventricular arrhythmias in the elderly population is a challenging problem. Elderly patients are more predisposed to arrhythmias, are less responsive to antiarrhythmic agents and are more susceptible to the adverse effects of antiarrhythmic agents. Results from recent trial have altered the general approach to management of ventricular arrhythmias. The results of the Cardiac Arrhythmia Suppression Trials (CAST I and II) exemplified the disappointing results from numerous other studies, revealing the overall lack of efficacy of class I agents in reducing mortality in patients with coronary artery disease and asymptomatic premature ventricular complexes (PVCs). The results of CAST I and II also demonstrated the higher likelihood of older patients developing ventricular arrhythmias and toxicity to antiarrhythmic agents. Combined results of these studies have discouraged empirical antiarrhythmic therapy, especially in older patients with asymptomatic PVCs. In contrast, secondary prevention trials with beta-blockers in post-myocardial infarction patients have shown definitive survival benefit and reduction in ventricular arrhythmias, especially in the older patient population. Smaller trials with amiodarone have also shown survival benefit in post-myocardial infarction patients with or without PVCs. Management of ventricular tachycardia and fibrillation has become less empirical and more systematic with use of electrophysiologically guided and/or Holter monitor-guided therapy. Sotalol and amiodarone are especially effective agents. The efficacy of implantable cardioverter/defibrillators are also being compared with medical therapy systematically in multicentre trials. In general, empirical antiarrhythmic therapy is discouraged especially in the treatment of asymptomatic PVCs and should be reserved for systematic use in life-threatening arrhythmias.

Duke Scholars

Published In

Drugs Aging

DOI

ISSN

1170-229X

Publication Date

June 1994

Volume

4

Issue

6

Start / End Page

462 / 469

Location

New Zealand

Related Subject Headings

  • Risk Factors
  • Humans
  • Heart Ventricles
  • Guidelines as Topic
  • Geriatrics
  • Cardiac Complexes, Premature
  • Arrhythmias, Cardiac
  • Anti-Arrhythmia Agents
  • Amiodarone
  • Aging
 

Citation

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Kim, C. H., Daubert, J. P., & Akiyama, T. (1994). Antiarrhythmic agents in older patients. Current state of knowledge. Drugs Aging, 4(6), 462–469. https://doi.org/10.2165/00002512-199404060-00003
Kim, C. H., J. P. Daubert, and T. Akiyama. “Antiarrhythmic agents in older patients. Current state of knowledge.Drugs Aging 4, no. 6 (June 1994): 462–69. https://doi.org/10.2165/00002512-199404060-00003.
Kim CH, Daubert JP, Akiyama T. Antiarrhythmic agents in older patients. Current state of knowledge. Drugs Aging. 1994 Jun;4(6):462–9.
Kim, C. H., et al. “Antiarrhythmic agents in older patients. Current state of knowledge.Drugs Aging, vol. 4, no. 6, June 1994, pp. 462–69. Pubmed, doi:10.2165/00002512-199404060-00003.
Kim CH, Daubert JP, Akiyama T. Antiarrhythmic agents in older patients. Current state of knowledge. Drugs Aging. 1994 Jun;4(6):462–469.
Journal cover image

Published In

Drugs Aging

DOI

ISSN

1170-229X

Publication Date

June 1994

Volume

4

Issue

6

Start / End Page

462 / 469

Location

New Zealand

Related Subject Headings

  • Risk Factors
  • Humans
  • Heart Ventricles
  • Guidelines as Topic
  • Geriatrics
  • Cardiac Complexes, Premature
  • Arrhythmias, Cardiac
  • Anti-Arrhythmia Agents
  • Amiodarone
  • Aging