Treatment of Chronic Atrial Fibrillation in the Elderly, Assessed by Ambulatory Electrocardiographic Monitoring

Abstract

This study concerns 8 elderly patients with age-related chronic atrial fibrillation that required control of the ventricular response. The effects of oral administration of placebo, pindolol, verapamil, digoxin and digoxin + pindolol were assessed (each for a week) during three daily activity and sleep sessions, over a six-week period. Cardiac rhythm was monitored by taped electrocardiograms. Either digoxin or pindolol was effective, but digoxin was the best tolerated of all the drugs. A combination of pindolol and digoxin reduced the maximum ventricular rate without further depression of the minimum ventricular rate. Digoxin seems to be well tolerated in the control of atrial fibrillation in the elderly, and beta blockade may be a useful therapeutic adjunct.

Chronic atrial fibrillation: a systematic review of medical heart rate control management

“…Wang et al studied the effect of pindolol with and without digoxin in a population of elderly patients 25. They found that individually pindolol and digoxin were equally effective at reducing ambulatory HR compared with placebo.…”

“…Monotherapy with verapamil has been examined in seven studies,23 25 30 50 57 – 59 and found to improve exercise HR compared with digoxin 50 58 59. In two studies there was also improvement in exercise tolerance,30 59 while in two others no improvement was demonstrated 23 58.…”

Iii. Digitalis in the Elderly

“…Perhaps the main indication for digoxin treatment in the elderly is uncontrolled atrial fibrillation (26). By slowing atrioventricular conduction, digoxin is effective in slowing ventricular rate, and hence improves cardiac output.…”

Digoxin Use in the Elderly

“…However, serum digoxin concentrations are useful in this setting to assess compliance in elderly patients whose ventricular response rates seem refractory to the usual doses of digoxin. In some elderly patients, as in younger patients, small doses of beta‐blocking agents should be added to maintenance digoxin therapy in order to achieve adequate rate control during exertion 49 . Higher doses of digoxin in these patients may precipitate toxicity without adequately controlling the ventricular response rate.…”