TREATMENT OF ARRHYTHMIAS IN THE ELDERLY: SPECIFIC AGE RELATED CONSIDERATIONS
S. Karlheinz Seidl, M.D., Klinikum Ingolstadt, Ingolstadt, Deutschland
The increasing pressure of caring for an aging population has an enormous impact on the health community. Atrial fibrillation – the arrhythmia of the elderly and interventional therapy like catheter ablation, ICD implantation in elderly and battery replacement in patients older than 85 years will concern us more and more in the future.
The benefits of these interventional treatment strategies for elderly patients (> 80 years of age) with respect to mortality, morbidity and stroke reductions remain unclear. The question how old is too old for these interventions has to be asked. An accurate assessment of biological age and quality of life is important in the assessment of elderly patients referred for these complex interventions. The assessment of frailty is emerging as an important marker for prognosis in cardiovascular disease. No randomized studies exits for the patient population. Several small studies demonstrated that elderly patients with AF benefit from AF-ablation, which is safe and effective in maintaining sinus rhythm and is associated with lower mortality and stroke risk. Similar findings were obtained regarding ICD Therapy. ICD therapy may remain effective in highly selected elderly patients at high risk of arrhythmic death. Biological rather than chronological age per se should be the decisive factor in making a decision on ICD selection or indication for AF ablation for survival benefit and improvement in quality of life.