Arrhythmias in Patients ≥80 Years of Age Pathophysiology, Management, and Outcomes

被引:104
作者
Curtis, Anne B. [1 ]
Karki, Roshan [1 ]
Hattoum, Alexander [1 ]
Sharma, Umesh C. [1 ]
机构
[1] SUNY Buffalo, Jacobs Sch Med & Biomed Sci, Dept Med, 100 High St,D2-76, Buffalo, NY 14203 USA
基金
美国国家卫生研究院;
关键词
ablation; antiarrhythmic drugs; electrophysiology; geriatrics; octogenarians; CARDIAC RESYNCHRONIZATION THERAPY; BUNDLE-BRANCH BLOCK; PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA; IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS; 2ND-DEGREE ATRIOVENTRICULAR-BLOCK; RECENT MYOCARDIAL-INFARCTION; LEFT-VENTRICULAR DYSFUNCTION; TERM CLINICAL-EFFICACY; SICK SINUS SYNDROME; ATRIAL-FIBRILLATION;
D O I
10.1016/j.jacc.2018.03.019
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Advances in medical care have led to an increase in the number of octogenarians and even older patients, forming an important and unique patient subgroup. It is clear that advancing age is an independent risk factor for the development of most arrhythmias, causing substantial morbidity and mortality. Patients >= 80 years of age have significant structural and electrical remodeling of cardiac tissue; accrue competing comorbidities; react differently to drug therapy; and may experience falls, frailty, and cognitive impairment, presenting significant therapeutic challenges. Unfortunately, very old patients are under-represented in clinical trials, leading to critical gaps in evidence to guide effective and safe treatment of arrhythmias. In this state-of-the-art review, we examine the pathophysiology of aging and arrhythmias and then present the available evidence on age-specific management of the most common arrhythmias, including drugs, catheter ablation, and cardiac implantable electronic devices. (C) 2018 by the American College of Cardiology Foundation.
引用
收藏
页码:2041 / 2057
页数:17
相关论文
共 109 条
[1]   Efficacy of cardiac resynchronization therapy in very old patients: the Insync/Insync ICD Italian Registry [J].
Achilli, Augusto ;
Turreni, Federico ;
Gasparini, Maurizio ;
Lunati, Maurizio ;
Sassara, Massimo ;
Santini, Massimo ;
Landolina, Maurizio ;
Padeletti, Luigi ;
Puglisi, Andrea ;
Bocchiardo, Mario ;
Orazi, Serafino ;
Perego, Giovanni Battista ;
Valsecchi, Sergio ;
Denaro, Alessandra .
EUROPACE, 2007, 9 (09) :732-738
[2]   Are Elderly Patients at Increased Risk of Complications Following Pacemaker Implantation? A Meta-Analysis of Randomized Trials [J].
Armaganijan, Luciana V. ;
Toff, William D. ;
Nielsen, Jens C. ;
Andersen, Henning R. ;
Connolly, Stuart J. ;
Ellenbogen, Kenneth A. ;
Healey, Jeff S. .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2012, 35 (02) :131-134
[3]   Ablation of Ventricular Tachycardia in the Very Elderly Patient With Cardiomyopathy: How Old Is Too Old? [J].
Barra, Sergio ;
Begley, David ;
Heck, Patrick ;
Turner, Ian ;
Agarwal, Sharad .
CANADIAN JOURNAL OF CARDIOLOGY, 2015, 31 (06) :717-722
[4]   Reverse Remodeling and the Risk of Ventricular Tachyarrhythmias in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy) [J].
Barsheshet, Alon ;
Wang, Paul J. ;
Moss, Arthur J. ;
Solomon, Scott D. ;
Al-Ahmad, Amin ;
McNitt, Scott ;
Foster, Elyse ;
Huang, David T. ;
Klein, Helmut U. ;
Zareba, Wojciech ;
Eldar, Michael ;
Goldenberg, Ilan .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2011, 57 (24) :2416-2423
[5]  
Bell FC, 2014 LIFE TABLES US
[6]   Impact of atrial fibrillation on the risk of death [J].
Benjamin, EJ ;
Wolf, PA ;
D'Agostino, RB ;
Silbershatz, H ;
Kannel, WB ;
Levy, D .
CIRCULATION, 1998, 98 (10) :946-952
[7]   Age dependence of complete heart block complicating radiofrequency ablation of the atrioventricular nodal slow pathway [J].
Boulos, M ;
Hoch, D ;
Schecter, S ;
Greenberg, S ;
Levine, J .
AMERICAN JOURNAL OF CARDIOLOGY, 1998, 82 (03) :390-+
[8]   Influence of age on the electrophysiological mechanism of paroxysmal supraventricular tachycardias [J].
Brembilla-Perrot, B ;
Houriez, P ;
Beurrier, D ;
Claudon, O ;
Burger, G ;
Vançon, AC ;
Mock, L .
INTERNATIONAL JOURNAL OF CARDIOLOGY, 2001, 78 (03) :293-298
[9]   Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of pre-excitation syndromes: a retrospective cohort study of 961 patients included over a 25-year period [J].
Brembilla-Perrot, Beatrice ;
Olivier, Arnaud ;
Sellal, Jean-Marc ;
Manenti, Vladimir ;
Brembilla, Alice ;
Villemin, Thibaut ;
Admant, Philippe ;
Beurrier, Daniel ;
Bozec, Erwan ;
Girerd, Nicolas .
BMJ OPEN, 2016, 6 (05)
[10]   Risk and Outcome after Ablation of Isthmus-Dependent Atrial Flutter in Elderly Patients [J].
Brembilla-Perrot, Beatrice ;
Sellal, Jean Marc ;
Olivier, Arnaud ;
Manenti, Vladimir ;
Villemin, Thibault ;
Beurrier, Daniel ;
De Chillou, Christian ;
Lamiral, Zohra ;
Girerd, Nicolas .
PLOS ONE, 2015, 10 (05)