Atrial fibrillation (AF) is an irregular and often rapid heart rate that can increase the risk of stroke, heart failure, and other heart-related complications. Its incidence increases with age and the presence of concomitant heart disease. We present the cases of a 93-year-old woman, an 82-year-old man, and an 87-year-old woman who developed AF tachycardia. This report highlights the use of a bisoprolol transdermal patch to treat AF tachycardia in 3 adult elderly patients. In this paper, we report an initial treatment strategy using a bisoprolol transdermal patch and show heart rate trends for 24 hours.wisepoqder Bisoprolol powder

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- (β-) 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).