Use of antiarrhythmic drugs in elderly patients

Hon Chi Lee, Kristin T.L. Huang, Win Kuang Shen

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

Human aging is a global issue with important implications for current and future incidence and prevalence of health conditions and disability. Cardiac arrhythmias, including atrial fibrillation, sudden cardiac death, and bradycardia requiring pacemaker placement, all increase exponentially after the age of 60. It is important to distinguish between the normal, physiological consequences of aging on cardiac electrophysiology and the abnormal, pathological alterations. The age-related cardiac changes include ventricular hypertrophy, senile amyloidosis, cardiac valvular degenerative changes and annular calcification, fibrous infiltration of the conduction system, and loss of natural pacemaker cells and these changes could have a profound effect on the development of arrhythmias. The age-related cardiac electrophysiological changes include up- and down-regulation of specific ion channel expression and intracellular Ca2+ overload which promote the development of cardiac arrhythmias. As ion channels are the substrates of antiarrhythmic drugs, it follows that the pharmacokinetics and pharmacodynamics of these drugs will also change with age. Aging alters the absorption, distribution, metabolism, and elimination of antiarrhythmic drugs, so liver and kidney function must be monitored to avoid potential adverse drug effects, and antiarrhythmic dosing may need to be adjusted for age. Elderly patients are also more susceptible to the side effects of many antiarrhythmics, including bradycardia, orthostatic hypotension, urinary retention, and falls. Moreover, the choice of antiarrhythmic drugs in the elderly patient is frequently complicated by the presence of co-morbid conditions and by polypharmacy, and the astute physician must pay careful attention to potential drug-drug interactions. Finally, it is important to remember that the use of antiarrhythmic drugs in elderly patients must be individualized and tailored to each patient's physiology, disease processes, and medication regimen.

Original languageEnglish (US)
Pages (from-to)184-194
Number of pages11
JournalJournal of Geriatric Cardiology
Volume8
Issue number3
DOIs
StatePublished - Oct 11 2011

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Keywords

  • Aging
  • Antiarrhythmic drugs
  • Cardiac electrophysiology
  • Ion channels
  • Pharmacodynamics
  • Pharmacokinetics
  • Polypharmacy

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Cardiology and Cardiovascular Medicine

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