Aetiology
The common causes of bradyarrhythmias are summarised in Table 1. In elderly patients, ischaemic heart disease and age-related fibrosis of the cardiac conducting system are common causes of bradyarrhythmias. In younger patients, congenital and autoinflammatory causes such as cardiomyopathies, sarcoidosis and infections are more commonly found. In approximately one quarter of patients who present to the emergency department (ED) with bradycardia, adverse drug reaction or intoxication is identified. For purposes of simplicity, we will break down the causes into ‘cardiac’ and ‘non-cardiac’ causes and explore the common cardiac causes of bradycardia.
| Table 1 – Causes of bradyarrhythmia. Adapted from Honarbakhsh et al; 2018. |
|---|
| Cardiac |
| Age related degeneration of conduction fibres / Sinus node dysfunction
Ischaemic heart disease (particularly affecting right coronary territory) Hypertensive heart disease Genetic (e.g. ryanodine receptor mutations) / Cardiomyopathies Iatrogenic – catheter ablations or coronary intervention |
| Metabolic |
| Thyrotoxicosis / Myxoedema
Electrolyte imbalance Alcohol |
| Inflammatory |
| Sarcoidosis
Amyloidosis |
| Infection |
| Rheumatic fever
Lyme disease |
| Drugs & Toxins |
| Calcium channel blockers
Tricyclic antidepressants Psychoactive drugs (e.g. SSRIs) Chemotherapy drugs |
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