Reviewing the use of antiarrhythmic drugs in elderly patients with atrial fibrillation.

IF 2.1 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Expert Review of Cardiovascular Therapy Pub Date : 2025-09-17 DOI:10.1080/14779072.2025.2561717

Danilo Menichelli, Gianluca Gazzaniga, Daniele Malatesta, Giordano Di Carlo, Tommaso Brogi, Arianna Pani, Pasquale Pignatelli, Daniele Pastori

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Abstract

Introduction: Atrial fibrillation (AF) is the most common arrhythmia in elderly patients. Antiarrhythmic drugs (AADs) are often required for rate/rhythm control and to improve AF-related symptoms. There is limited evidence on the effectiveness and safety of AADs in elderly AF patients.

Areas covered: This narrative review focuses on the use of AADs in elderly AF patients, summarizing the different physiology, pharmacokinetics, and pharmacodynamics in the older age. Furthermore, the evidence from clinical studies on AADs pointing up data on safety and effectiveness in the elderly was summarized.

Expert opinion: Although AADs represent a cornerstone for symptom relief in patients with AF, these drugs did not show a clinical net benefit compared to rate control, with a potentially increased risk of complications and hospitalizations. Considering also the different pharmacokinetics and the concomitant comorbidities and treatments that characterize older patients, the administration of these drugs should be reserved for selected patients with a high burden of AF-related symptoms.

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老年房颤患者抗心律失常药物的应用综述。

房颤（AF）是老年患者最常见的心律失常。抗心律失常药物（AADs）通常用于控制心率/节律和改善心房颤动相关症状。关于AADs在老年房颤患者中的有效性和安全性的证据有限。涉及领域：本文综述了AADs在老年房颤患者中的应用，总结了老年患者不同的生理、药代动力学和药效学。此外，总结了AADs在老年人中的安全性和有效性的临床研究证据。专家意见：尽管AADs是缓解房颤患者症状的基础，但与速率控制相比，这些药物并未显示出临床净收益，潜在的并发症和住院风险增加。此外，考虑到老年患者不同的药代动力学和伴随的合并症和治疗方法，这些药物的施用应保留给有af相关症状高负担的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

3.70

自引率

0.00%

发文量

期刊介绍： Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.