Electrophysiology and heart rhythm disorders in older adults

Heart rhythm disorders, including bradyarrhythmias, atrial fibrillation (AF), and ventricular arrhythmias, become increasingly common with aging and represent important causes of morbidity and mortality among older adults. Older adults are particularly predisposed to these conditions due to the high prevalence of cardiovascular disease in conjunction with age-related changes that occur in the heart and cardiac conduction system. Management of heart rhythm disorders often differs in older compared to younger individuals due to reduced life expectancy, multimorbidity, polypharmacy, and increased vulnerability to adverse effects of therapies. The presence of geriatric syndromes, particularly frailty, and cognitive impairment, which have been increasingly recognized as important factors associated with poor outcomes in many cardiovascular conditions, further contribute to the complexity of decision-making in this vulnerable population. Accordingly, this review seeks to describe the evaluation and treatment of common rhythm disturbances among older adults.