THE MANAGEMENT OF VENTRICULAR ARRHYTHMIAS IN OLDER PATIENTS AFTER CAST

Asymptomatic nonsustained ventricular tachycardia and complex ventricular arrhythmias in elderly persons without heart disease should not be treated with antiarrhythmic drugs. Nonsustained ventricular tachycardia and complex ventricular arrhythmias in elderly persons are associated with an increased incidence of coronary events, primary ventricular fibrillation and sudden cardiac death, especially if abnormal left ventricular ejection fraction, left ventricular hypertrophy or silent ischaemia are present. beta-Blockers should be used in the treatment of elderly patients with ventricular tachycardia or complex ventricular arrhythmias associated with ischaemic or nonischaemic heart disease if there are no contraindications to beta-blocker therapy. I would reserve the use of amiodarone in the treatment of ventricular tachycardia or complex ventricular arrhythmias to life-threatening ventricular tachyarrhythmias in elderly patients who cannot tolerate or who do not respond to beta-blockers.