ABC | Volume 112, Nº5, May 2019

Updated Updated Geriatric Cardiology Guidelines of the Brazilian Society of Cardiology – 2019 Arq Bras Cardiol. 2019; 112(5):649-705 with an increase in total mortality, cardiac mortality, and sudden death. The worse the ventricular dysfunction, the more complex and severe the ventricular arrhythmia will be. Thus, patients with LV dysfunction or LVH with complex ventricular arrhythmia should be considered at a high risk of sudden death, even if they are asymptomatic. In elderly patients without heart disease, the finding of tachyarrhythmias on Holter has no prognostic implications. 286 Based on these premises, with respect to diagnostic evaluation of tachyarrhythmias in elderly patients, these Guidelines recommend: Recommendation Grade of recommendation Level of evidence Inquiry about all medications in use and risk analysis of induced arrhythmias or prolonged QT I C 12-derivation EKG in all patients at each clinical visit, even in the absence of symptoms I C Calculation of QTc interval for all patients who report palpitation I C Calculation of QT interval for all patients with polymorphic VT I B 24-h Holter to evaluate symptoms of palpitation, syncope, and unexplained falls I B 24-h Holter for asymptomatic patients with normal LV function and EKG with LVH IIa B 24-h Holter for asymptomatic patients with depressed LV function and EKG with LVH I A 24-h Holter for patients recovered from VF/VT before hospital discharge IIa C 24-h Holter for patients recovered from VF/VT during outpatient follow-up to evaluate therapy efficacy IIb C 24-h Holter for asymptomatic patients with simple ventricular arrhythmia during the initial exam, with normal LV function and EKG with LVH, during outpatient follow-up to evaluate therapy efficacy III C 24-h Holter for asymptomatic patients with complex ventricular arrhythmia during the initial exam, with normal LV function and EKG with LVH, during outpatient follow-up to evaluate therapy efficacy IIb C 24-h Holter for asymptomatic patients with simple ventricular arrhythmia during the initial exam, with depressed LV function and EKG with LVH, during outpatient follow-up to evaluate therapy efficacy III C 24-h Holter for asymptomatic patients with complex ventricular arrhythmia during the initial exam, with depressed LV function and EKG with LVH, during outpatient follow-up to evaluate therapy efficacy IIa C 24-h Holter for asymptomatic patients with normal LV function and EKG III B Ergometric test in patients without contraindications who have effort- induced palpitations I C Ergometric test in patients without contraindications who have palpitations associated with chest angina I C Ergometric test in patients without contraindications who have resting palpitations III C Ergometric test in asymptomatic patients without contraindications to investigate arrhythmia III C Echocardiogram in all patients with palpitations IIb B Echocardiogram in patients with LVH on EKG, asymptomatic patients IIa B Echocardiogram in patients with palpitation and dyspnea I B Echocardiogram in patients with LVH and cardiac murmur, asymptomatic patients I B Investigation of ischemic etiology in all patients with supraventricular tachycardia III C Investigation of ischemic etiology in all patients with supraventricular tachycardia and angina I C Investigation of ischemic etiology in all patients with complex ventricular tachycardia I C Magnetic resonance in patients with complex ventricular arrhythmia, whose other exam results are normal, to investigate arrhythmogenic RV dysplasia, myocardial fibrosis, and asymmetric apical hypertrophy I C Magnetic resonance in all patients with VT III C Magnetic resonance in all patients with SVT III C EPS in patients with high SD risks (unexplained syncope and complex ventricular arrhythmia on Holter or trifascicular block, in order to clarify syncope etiology) I C EKG: electrocardiogram; EPS: electrophysiological study; LV: left ventricle; LVH: left ventricular hypertrophy; RV: right ventricle; SD: sudden death; SVT: supraventricular tachyarrhythmia; VF: ventricular fibrillation; VT: ventricular tachycardia. 689