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Cardiac Arrhythmias

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Geriatric Diseases

Abstract

Cardiac arrhythmias are a large concern among the elderly with increasing prevalence. Atrial premature contractions increase with age and were seen in up to 95% of older healthy volunteers at rest and during exercise in the absence of detectable cardiac disease. About 40% of the people who die from cardiovascular disease suffer from arrhythmias. Atrial fibrillation is common in the elderly, and the incidence and prevalence increase with age, with a prevalence of 8% in people 80 years and over. Drug therapy has a key role in the treatment of arrhythmias especially in long-term therapy. There are an array of procedures and devices for non-pharmacological treatment of arrhythmias. In elderly patients with AF, there is an increased risk of heart failure and embolic events which have a negative effect on the QoL and mental function. The present review will highlight the improvement that has occurred in clinical care.

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References

  1. Manyari DE, Patterson C, Johnson D, Melendez L, Kostuk WJ, Cape RD. Atrial and ventricular arrhythmias in asymptomtic active elderly subjects correlation with left atrial size and left ventricular mass. Am Heart J. 1990;119(5):1069–76.

    Article  CAS  PubMed  Google Scholar 

  2. Mirza M, Strunets A, Shen WK, Jahangir A. Mechanisms of arrhythmia and conduction disorders in older adults. Clin Geriatr Med. 2012;28(4):555–73.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM, et al. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study) Am J Cardiol. 1994;74:236–241.

    Article  CAS  PubMed  Google Scholar 

  4. Fleg JL. Venricular arrthythmias in the elderly:prevalence, mechanism and therapeutic implications. Geriatrics. 1988;43(12):23.

    CAS  PubMed  Google Scholar 

  5. Swartz JB. Cardiovascular function and disease in the elderly. 1999. http://www.galter.northwestern/edu/casrdiovascular_function_disease.cfm accessed on 3 January 2014.

  6. Fleg JL, Kennedy HL. Cardiac arrhythmias in healthy elderly population: detection by 24-hour ambulatory electrcardiography. Chest. 1982;81:302–07.

    Article  CAS  PubMed  Google Scholar 

  7. ACC/AHA/ESC Pocket Guidelines, September 2006.

    Google Scholar 

  8. Dresing TJ, Wilkoff B. Bradyarrhythmias. Curr Treat Options Cardiovasc Med. 2001;3(4):291–298.

    Article  PubMed  Google Scholar 

  9. Smit JPP, Veldkamp MW, Wilde AAM. Mechanisms of inherited cardiac conduction disease. Europace. 2005;7(2):122–137.

    Article  Google Scholar 

  10. Harrison ‘s principles of internal medicine as quoted by Smits et al, 2005.

    Google Scholar 

  11. Chase D, O’Donell D Farouque O. Management of cardiac rhythm disturbances in the ageing heart. J Pharm Pract and Res. 2008;38: 312–317.

    Article  Google Scholar 

  12. Steinberg BA, Briderik SH, Lopes RD, Shaw LK, Thomas KL, DeWald TA, et al. Use of antiarrhythmic drug therapy and clinical outcomes in older patients with concomitant atrial fibrillation and coronary heart disease. Eurpace. 2014;16:1284–9.

    Article  Google Scholar 

  13. American Heart Association. Heart disease and stroke statistics. 2010 update. A report fronm the American Heart Association. Circulation. Journal of the American Heart Association. 120;46–215. (http://www.american heart org/presentation.jhtml/identifier=94).

  14. Klabunde RE. Antiarrhythmic drugs. Cardiovasc Pharmacol Concepts. http://www.cvpharmacoology.com/antiarrhy/antiarrhythmic.htm retreived. 1/27/2008.

  15. Aronow WS. Management of atrial fibrillation in the elderly. Minerva Med. 2009;100(1):3–24.

    CAS  PubMed  Google Scholar 

  16. Steinberg JS, Martins JM, Sadanandan SM, Goldner B, Menchavez E, Domanski M, et al. Antiarrythmic drugs use in the implantable defibrillator arm of the Antiarrhythmics versus Implantable Defibrillators (AVD) Study. Am Heart J. 2001;142:520–9.

    Article  CAS  PubMed  Google Scholar 

  17. Kreeger RW, Hammill SC. New antiarrhythmic drugs: tocainide, mexiletine, flecainide, encainide and amiodarone. May Clin Proc. 1987;62(11):1033–60.

    Article  CAS  Google Scholar 

  18. Yalta K,Turgut OO, Yilmaz MB, Tandogan I. Dronedrone: a promising alternative for the management of atrial fibrillation. Cardiovasc Drugs Ther. 2009;23(5):385–93.

    Article  CAS  PubMed  Google Scholar 

  19. Chen J, Hocini M, Lsrsen TB, Proclemer A, Sciaraffia E, Blomstrom-Lundqvist C for the Scientific Initiative Committee, European Heart Rhythm Association. Eurospace. 2015;17:314–317.

    Google Scholar 

  20. Kozluk E. Pathophysiological mechanisms of cardiac arrhythmias as a key for optimal nonpharmacological treatment. J Physiol Pharmol 2006; 57 Suppl 11: 69–77.

    Google Scholar 

  21. Van Gelder IC, Brugemann J, Criins HJ. Pharmacological management of arrhythmias in the elderly. Drugs Aging. 1997;11(2):96–110.

    Article  PubMed  Google Scholar 

  22. Wolfe PA, Dawber TR, Thomas HE Jr, Kannel WB. Epidemiological assessment of chronic atrial fibrillation and risk of stroke: the Framingham Study. Neurology. 1978; 28:973–977.

    Article  Google Scholar 

  23. Wolf PA, Abbott RD, Kannel WD. Atrial fibrillation as an independent factor for stroke: the Framingham study. Stroke. 1991;22:983–988.

    Article  CAS  PubMed  Google Scholar 

  24. Singer DF. Anticoagulation to prevent stroke in atrial fibrillation and its implications for managed care. Am J Cardiol. 1998; 81:850.

    Article  Google Scholar 

  25. Fuster V, Ryden LE, Asinger RW, Cannom DS, Crijns HJ, Frye RL, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation executive summary a report of the American College of Cardiology/American Heart Association task force in practice guidelines and the European Society of Cardiology committee for practice guidelines and policy conferences (committee to develop guidelines for the management of patients with atrial fibrillation developed in collaboration with the North American Society of Pacing and Electrophysiology). Circulation. 2001;101:2118–50.

    Google Scholar 

  26. Agarwal SK, Heiss G, Rautaharju PM, Shaher E, Messing MW, Simpson RJ Jr. Premature ventricular complexes and risk of incident stroke: the Atherosclerosis Risk in Communities (ARIC) Study. Stroke. 2010; 41: 588–593.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Worthington JM, Gattellari M, Leung DY. ‘Where There’s Smoke….Are premature ventricular complexes a new risk factor for stroke?. Stroke. 2010; 41: 572–573.

    Article  PubMed  Google Scholar 

  28. Lubitz SA, Benjamin EJ, Ruskin JN, Fuster V, Ellinor PT. Changes in the classification of atrial fibrillation. Nat Rev Cardiol. 2010; August (8):451–60.

    Google Scholar 

  29. Choudhury A, Lip GY. Antiarrhythmic drugs in atrial fibrillation: an overview of new agents, their mechanisms of action and potential clinical utility. Expert Opin Investig Drugs. 2004;13(7):841–55.

    Article  CAS  PubMed  Google Scholar 

  30. Kalus JS. Pharmacologic management of atrial fibrillation: established and emerging options. J Manag Care Pharm. 2009;156 Supl B): S10-8.

    Google Scholar 

  31. Fuster V. ACC/AHA/ESC. Circulation. 2006;114(7):e257–354.

    Article  PubMed  Google Scholar 

  32. Lip GYH, Li Saw Hee FL. Paroxysmal atrial fibrillation. QJM 2001;94(12):665–678. https://doi.org/10.1093/qjmed/94.12.665.

    Article  CAS  PubMed  Google Scholar 

  33. Wyse DG, Waldon AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347:1825–33.

    Article  CAS  PubMed  Google Scholar 

  34. Markides V, Schilling RJ. Atrial fibrillation: classification, pathophysiology, mechanisms and drug treatment. Heart 2003;89:939–942.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Connolly SJ, Crijns HJ, Torp-Pedersen C, van Eickels M, Gaudin C, Page RL, et al. for the ATHENA investigators. Analysis of stroke in ATHENA: a placebo-controlled double-blind, parallel-arm trial to assess the efficacy of dronedarone: 400 mg BID for the prevention of cardiovascular hospitalization or death from any cause in patients with atrial fibrillation/atrial flutter. Circulation. 2009; 120:1174–1180.

    Google Scholar 

  36. Hohnloser SH, Crijns HJGM, van Eickels M, Gaudin C, Page RL, Torp-Pedersen C, et al for the ATHENA Investigators. Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med. 2009;360: 668–678.

    Google Scholar 

  37. Fuster V, Ryden LE, Cannom DS, Crijns HL, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation. Eur Heart J. 2006;27:1979–2030.

    Article  PubMed  Google Scholar 

  38. Olshansky B, Rosenfeld LE, Warner, Solomon AJ, O’Neill G, Sharma A, et al. The atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study: approaches to control of rate in atrial fibrillation. J Am Coll Cardiol. 2004;43:1201–1208.

    Article  PubMed  Google Scholar 

  39. Rawles JM, Metcalfe MJ, Jennings K. Time of occurrence, duration and ventricular rate of paroxysmal atrial fibrillation: the effects of digoxin. Br Heart J. 1990;63:225–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Cappato R, Calkins H, Chen SA, Davies W, Lesaka Y, Kalman J, et al. Worldwide survey on the methods, efficacy and safety of catheter ablation for human atrial fibrillation. Circulation. 2005;111:1100–1106.

    Article  PubMed  Google Scholar 

  41. Pappone C, Santinelli V. Ablation of atrial fibrillation. Eur Cardiovasc Dis. 2008;4:96–98.

    Google Scholar 

  42. Kalman JM, Sanders P, Brieger DB, Aggarwal A, Zwar NA, Tatoulis J, et al. National Heart Foundation of Australia consensus statement on catheter ablation as a therapy for atrial fibrillation. MJA. 2013;198:27–28.

    PubMed  Google Scholar 

  43. Limantro I, Weijs B, Crijns H, Pisters R. The impact of atrial fibrillation on the quality of life of the elderly. http://www.medscape.com/viewarticle/771812./

  44. Gage BF, van Walraven C, Pearce L, Hart PG, Kondstaal PJ, Boode BS, et al. Selecting patients with AF for anticoagulation: stroke risk stratification in patients taking aspirin. Circulation. 2004;110:2287–92.

    Article  CAS  PubMed  Google Scholar 

  45. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke results from the National Registry of Atrial fibrillation. JAMA. 2001; 285:2860–70.

    Article  Google Scholar 

  46. Lip GYH, Frison L, Halperin JL, Lane DA. Identifying patients at high risk stratification schemes in an anticoagulated atrial fibrillation cohort. Stroke 2010;41: 2731–2738.

    Article  CAS  PubMed  Google Scholar 

  47. Olesen JB, Torp-Pedersen C, Hansen ML, Lip GY. The value of score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0-1: a nationwide cohort study. Thromb Haemost 2012;197(6):1172–9.

    Google Scholar 

  48. Camm AJ, Lip GY, De Caerina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrills to: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with special contribution of the European Heart Rhythm Association. Europae 2012;14:1385–41.

    Google Scholar 

  49. Camm AJ, Kirchhof P, Lip GY, Schotten U, SAvelieva I, Ernst S, van Gelder IC, et al. European Heart Rhythm Association; European Association for cardio-Thoracic Surgery, Guidelines for the management of atrial fibrillation: The task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC), Eur Heart J. 2010;31:2369–429.

    Google Scholar 

  50. Lip GY. Implications of CHA2DS2-VASc and HAS-BLED scores for thromboprophylaxis in atrial fibrillation. Am J Med. 2011;124(2):111–4.

    Article  PubMed  Google Scholar 

  51. Connolly S, Pogue J, Hart R, Pfeffer M, Hohnloser S, Chrolavicius S, et al. ACTIVE investigators. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial Fibrillation Clopidogrel Trial with Irbesartan for the prevention of Vascular EVENTS (ACTIVE W): a randomized controlled trial. Lancet. 2006;367:1903–12.

    Google Scholar 

  52. Connolly SJ, Pogue J, Hart RG, Hohnloser S, Pfeffer M, Chrolavicius S, et al. ACTIVE investigators. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Eng J Med. 2009;360:2066–78.

    Google Scholar 

  53. Connolly S, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Perekh A, et al. Dabigatran vs warfarin in patients with atrial fibrillation. NEJM. 2009;361:1139–1151.

    Article  CAS  PubMed  Google Scholar 

  54. Gallus A. New oral anticoagulants-clinical applications. Aust Prescr. 2010;33:42–47.

    Article  Google Scholar 

  55. Nutescu EA, Shapiro NL, Chevalier A, Amin AN. A pharmacologic overview of current and emerging anticoagulants. Cleve Clin Med. 2005;72. Suppl 1: S2-S6.

    Article  Google Scholar 

  56. ROCKET AF Study Investigators. Rivaroxaban-once daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism in atrial fibrillation: rationale and design of the ROCKET AF Study. Am Heart J. 2010;159:340–347.

    Article  Google Scholar 

  57. Granger CB, Alexander JH, McMurray JJ, Lopez RD, Hylek EM, Hanna M, et al. ARISTOTLE –Committiees and Investigators: Apixaban versus warfarin in patients with atrial fibrillation. NEJM. 2011;365:981–982.

    Google Scholar 

  58. Sadar P, Chatterjee S, Chaudhari S, Lip GY. New oral anticoagulants in elderly adults: evidence from a meta-analysis of randomized trials. J Am Griatr Soc. 2014;62:857–64.

    Article  Google Scholar 

  59. Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J et al. European Heart Rhythm Association Practical Guide on the use of new anticoagulants inpatients with non-valvular atrial fibrillation: executive summary. Europace. 2013;15:625–51.

    Article  PubMed  Google Scholar 

  60. Legrand M, Mateo L, Ariband A, Ginisty S, Eftekhari P, Huy PT, et al. The use of dabigatran in elderly patients. Arch Intern Med. 2011;171:1281–1286.

    Article  Google Scholar 

  61. Harper P, Young PL, Merriman L. Bleeding risk with dabigatran in the frail elderly. N Eng J Med. 2012;366:864–865.

    Article  CAS  Google Scholar 

  62. Melioni C, Peterson ED, Chen AV, Szczech LA, Newby LK, Harrington RA, et al. Cockcroft-Gault versus modification of diet in renal disease: importance of glomerular filtration rate formula for classification of chronic kidney disease in patients with non-ST segment elevation acute coronary syndrome. J Am Coll Cardiol. 2008;51:991–996.

    Article  Google Scholar 

  63. Fragakis N, Katsaris G. Arrhythmias in the elderly: Modern management. Hellenic J. 2006;47:844–92.

    Google Scholar 

  64. Sabatini T, Frisoni GE, Barbisoni P, Bellelli G, Rozzini R, Trabucchi M. Atrial fibrillation and cognitive disorders in elderly people. J Am Geriatr Soc. 2000;45:387–390.

    Article  Google Scholar 

  65. Ott A, Breteler MD, de Bruyne C, van Harskamp F, Grobbee DE, Hofman A. Atrial fibrillation and dementia in a population based study. The Rotterdam Study. Stroke. 1997;28:311–321.

    Article  Google Scholar 

  66. Hickey KT, Reiffel J, Sciacca RR, Whang W, Biviano A, Baumeister M, et al. Correlating perceived arrhythmia symptoms and QoL in the elderly with heart failure in an urban clinic: A prospective study. J Clin Nurs. 2013;22(0):434–444.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Roalfe AK, Bryant TL, Davies MH, Hackett TG, Sana S, Fletcher K, et al. A cross-sectional study of quality of life in an elderly population (75 years and over) with atrial fibrillation: secondary analysis of data from the Birmingham Atrial Fibrillation Treatment of the Aged study. Europace. https://doi.org/10.1093/europaace/eus102 1420–1427. 10 May 201.

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Nagaratnam, N., Nagaratnam, K., Cheuk, G. (2018). Cardiac Arrhythmias. In: Geriatric Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-33434-9_2

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  • DOI: https://doi.org/10.1007/978-3-319-33434-9_2

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