Management of the older person with ventricular arrhythmias.

OBJECTIVE: To review the prognosis and management of ventricular arrhythmias (VA) in persons with and without heart disease, with emphasis on older adults.

DATA SOURCES: A computer-assisted search of the English language literature (MEDLINE database) followed by a manual search of the bibliographies of pertinent articles.

STUDY SELECTION: Studies on the prognosis and management of VA in persons with and without heart disease were screened for review. Studies in older persons and recent studies were emphasized.

DATA EXTRACTION: Pertinent data were extracted from the reviewed articles. Emphasis was placed on studies involving older persons. Relevant articles were reviewed in depth.

DATA SYNTHESIS: Available data on the prognosis and management of VA in persons with and without heart disease, with emphasis on studies in older persons, were summarized.

CONCLUSIONS: Ventricular arrhythmias in older persons without heart disease should not be treated with antiarrhythmic drugs, nor should Class I antiarrhythmic drugs be used to treat VA in older persons with heart disease. Beta-blockers should be used to treat complex VA in older persons with ischemic or nonischemic heart disease without contraindications to beta-blockers. Amiodarone should be reserved for life-threatening ventricular tachyarrhythmias in older persons who cannot tolerate or who do not respond to beta-blockers. Angiotensin-converting enzyme inhibitors should be used to treat older persons with heart failure, an anterior myocardial infarction, or a left ventricular ejection fraction < or = 40%. If older persons have life-threatening recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) resistant to antiarrhythmic drugs, invasive intervention should be performed. The automatic implantable cardioverter-defibrillator is recommended in older persons who have medically refractory sustained VT or VF.