1. Introduction
Clinical atrial fibrillation (AF) is associated with increased rates of stroke, heart failure, mortality, hospitalization, and cognitive
decline, much of which may present suddenly and constitute irretrievable
harm [1, 2]. AF symptoms often include heart palpitations, shortness of
breath, and weakness. Rate control is possible in the majority of
patients with AF. Beta- (ß-) blockers have been the most effective drugs
[3]. However, swallowing tablets or capsules is sometimes difficult for
elderly people because of dysphagia [4]. Moreover, aspiration pneumonia
can be associated with dysphagia [5]. Bisoprolol is also available as a
transdermal patch in Japan. Medication adherence is better with the use
of a transdermal patch than with the use of tablets, particularly in
elderly patients who might have difficulty with oral administration. In
this paper, we report an initial treatment strategy for AF tachycardia
using a bisoprolol transdermal patch in elderly patients.
2. Case Presentation
This 93-year-old woman, a resident of a special elderly care nursing home, was referred to our hospital for the treatment of cellulitis. She
related a history of treatment for hypertension and atrial fibrillation
(AF). Upon arrival, her blood pressure (BP) was 119/83?mmHg and heart
rate (HR) was 82?bpm. An electrocardiogram (ECG) demonstrated AF and a
complete right bundle branch block (Figure 1(a)). During the treatment
for cellulitis using antibiotics, she complained of dyspnea. Her HR
increased to 140?bpm and her chest X-ray (CXR) showed pulmonary edema
and congestion (Figure 1(b)). Echocardiography demonstrated preserved
cardiac contractility with an ejection fraction (EF) of 60%, indicating
heart failure with a preserved EF. She was administered furosemide
(20?mg/day) to treat heart failure. In addition, a bisoprolol
transdermal patch (2?mg) was applied to her chest. Her HR trends were
significantly decreased within 8 hours and the control of HR continued
for 24 hours (Figure 2). Eventually, her CXR and symptoms improved.
An 82-year-old man was admitted to our hospital for the treatment of ileus. He related a history of treatment for persistent AF and
hypertension. He was administered bisoprolol fumarate tablets
(2.5?mg/day) for AF before admission. His HR on admission was 87?bpm.
However, he could not take oral medicine because of fasting for
treatment of ileus. After 3 days of fasting, he developed AF tachycardia
and his HR increased to 150?bpm. Bisoprolol transdermal patch (4?mg)
was applied to his chest. This dose was equal to a 2.5?mg bisoprolol
fumarate tablet. His HR trends were significantly decreased after 8
hours of bisoprolol transdermal patch, and the frequency and duration of
AF decreased until 24 hours after administration (Figure 3).
