Ventricular Arrhythmias in the Elderly

The management of malignant ventricular arrhythmias will become gradually more important as life expectancy continues to increase. The incidence of sudden cardiac death and overall cardiac mortality is more pronounced in the elderly mainly as a reflection of the higher prevalence of ischemic heart disease. With the exception of beta-blocker therapy, antiarrhythmic drug therapy has not proven to be effective in the prevention of sudden cardiac death. Implantable cardioverter-defibrillator therapy has been shown to reduce both overall mortality and arrhythmic death when following current guidelines for implantation and appears to be applicable to any age group when sensible patient selection is implemented. The greater efficacy of this therapy relative to antiarrhythmic therapies supports its expanded use in the elderly population. Such therapy has a similar cost-effectiveness to other accepted interventions and does not appear to be associated with reduced quality of life or age-specific complications. The clinical approach to elderly patients at risk of sudden death from ventricular arrhythmias will continue to evolve as new technologies are developed, but the future of ventricular arrhythmia treatment in the elderly will likely emphasize an increasing utilization of both implantable cardioverter-defibrillator and beta-blocker therapies.