Cardiac Arrhythmias

  • Nages Nagaratnam
  • Kujan Nagaratnam
  • Gary Cheuk
Reference work entry

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.

Keywords

Cardiac arrhythmias Atrial fibrillation Multiform ventricular ectopy Drug therapy Procedures and devices for non-pharmacological treatment 

References

  1. 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.CrossRefPubMedGoogle Scholar
  2. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 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.CrossRefPubMedGoogle Scholar
  4. 4.
    Fleg JL. Venricular arrthythmias in the elderly:prevalence, mechanism and therapeutic implications. Geriatrics. 1988;43(12):23.PubMedGoogle Scholar
  5. 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. 6.
    Fleg JL, Kennedy HL. Cardiac arrhythmias in healthy elderly population: detection by 24-hour ambulatory electrcardiography. Chest. 1982;81:302–07.CrossRefPubMedGoogle Scholar
  7. 7.
    ACC/AHA/ESC Pocket Guidelines, September 2006.Google Scholar
  8. 8.
    Dresing TJ, Wilkoff B. Bradyarrhythmias. Curr Treat Options Cardiovasc Med. 2001;3(4):291–298.CrossRefPubMedGoogle Scholar
  9. 9.
    Smit JPP, Veldkamp MW, Wilde AAM. Mechanisms of inherited cardiac conduction disease. Europace. 2005;7(2):122–137.CrossRefGoogle Scholar
  10. 10.
    Harrison ‘s principles of internal medicine as quoted by Smits et al, 2005.Google Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 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. 14.
    Klabunde RE. Antiarrhythmic drugs. Cardiovasc Pharmacol Concepts. http://www.cvpharmacoology.com/antiarrhy/antiarrhythmic.htm retreived. 1/27/2008.
  15. 15.
    Aronow WS. Management of atrial fibrillation in the elderly. Minerva Med. 2009;100(1):3–24.PubMedGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 17.
    Kreeger RW, Hammill SC. New antiarrhythmic drugs: tocainide, mexiletine, flecainide, encainide and amiodarone. May Clin Proc. 1987;62(11):1033–60.CrossRefGoogle Scholar
  18. 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.CrossRefPubMedGoogle Scholar
  19. 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. 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. 21.
    Van Gelder IC, Brugemann J, Criins HJ. Pharmacological management of arrhythmias in the elderly. Drugs Aging. 1997;11(2):96–110.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefGoogle Scholar
  23. 23.
    Wolf PA, Abbott RD, Kannel WD. Atrial fibrillation as an independent factor for stroke: the Framingham study. Stroke. 1991;22:983–988.CrossRefPubMedGoogle Scholar
  24. 24.
    Singer DF. Anticoagulation to prevent stroke in atrial fibrillation and its implications for managed care. Am J Cardiol. 1998; 81:850.CrossRefGoogle Scholar
  25. 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. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 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.CrossRefPubMedGoogle Scholar
  28. 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. 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.CrossRefPubMedGoogle Scholar
  30. 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. 31.
    Fuster V. ACC/AHA/ESC. Circulation. 2006;114(7):e257–354.CrossRefPubMedGoogle Scholar
  32. 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.CrossRefPubMedGoogle Scholar
  33. 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.CrossRefPubMedGoogle Scholar
  34. 34.
    Markides V, Schilling RJ. Atrial fibrillation: classification, pathophysiology, mechanisms and drug treatment. Heart 2003;89:939–942.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 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. 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. 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.CrossRefPubMedGoogle Scholar
  38. 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.CrossRefPubMedGoogle Scholar
  39. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 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.CrossRefPubMedGoogle Scholar
  41. 41.
    Pappone C, Santinelli V. Ablation of atrial fibrillation. Eur Cardiovasc Dis. 2008;4:96–98.Google Scholar
  42. 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.PubMedGoogle Scholar
  43. 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. 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.CrossRefPubMedGoogle Scholar
  45. 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.CrossRefGoogle Scholar
  46. 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.CrossRefPubMedGoogle Scholar
  47. 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. 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. 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. 50.
    Lip GY. Implications of CHA2DS2-VASc and HAS-BLED scores for thromboprophylaxis in atrial fibrillation. Am J Med. 2011;124(2):111–4.CrossRefPubMedGoogle Scholar
  51. 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. 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. 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.CrossRefPubMedGoogle Scholar
  54. 54.
    Gallus A. New oral anticoagulants-clinical applications. Aust Prescr. 2010;33:42–47.CrossRefGoogle Scholar
  55. 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.CrossRefGoogle Scholar
  56. 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.CrossRefGoogle Scholar
  57. 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. 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.CrossRefGoogle Scholar
  59. 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.CrossRefPubMedGoogle Scholar
  60. 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.CrossRefGoogle Scholar
  61. 61.
    Harper P, Young PL, Merriman L. Bleeding risk with dabigatran in the frail elderly. N Eng J Med. 2012;366:864–865.CrossRefGoogle Scholar
  62. 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.CrossRefGoogle Scholar
  63. 63.
    Fragakis N, Katsaris G. Arrhythmias in the elderly: Modern management. Hellenic J. 2006;47:844–92.Google Scholar
  64. 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.CrossRefGoogle Scholar
  65. 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.CrossRefGoogle Scholar
  66. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 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.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nages Nagaratnam
    • 1
  • Kujan Nagaratnam
    • 1
  • Gary Cheuk
    • 2
  1. 1.The University of SydneyWestmead Clinical SchoolWestmeadAustralia
  2. 2.Rehabilitation and Aged Care ServiceBlacktown-Mt Druitt HospitalMount DruittAustralia

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