Bradycardia and tachycardia occurring in older people: investigations and management

In the elderly, the investigation of symptoms potentially due to an arrhythmic cause is similar to that for a younger person. In many cases, however, a history obtained from a friend or relative can be valuable. Routine investigations should include tests of thyroid function, an electrocardiogram (ECG), and ambulatory ECG recording. In patients without cerebrovascular disease, carotid sinus massage with continuous ECG monitoring should be performed.
The role of device therapy in the management of arrhythmias in patients of all ages is increasing. Permanent pacing can improve symptoms and prognosis in patients with certain bradycardia, and the indications for pacing are available in contemporary international guidelines. Recent developments in device therapy include multisite pacing and implantable cardioverter defibrillators. Emerging data suggest that these devices can be used to good effect in selected elderly patients.