6th March 2024

Management

Reversible causes should be treated initially and further treatment guided by the underlying mechanism for the bradycardia. The specific therapies are included in their respective sections below. In certain arrhythmias e.g., sick sinus disease or 1st degree AV node block, asymptomatic patients are likely to be monitored and interventions only to be considered if symptoms – such as pre-syncope, syncope or dyspnoea from chronotropic incompetence – develop. 

In haemodynamic instability, the heart rate should be increased to promote cardiac output through pharmacological or electrical means. Atropine and or isoprenaline are typically used. Atropine, an antimuscarinic drug that reduces parasympathetic activity, while Isoprenaline is a non-selective beta adrenoreceptor agonist that targets beta receptors of the sympathetic nervous system; both influence the SA and AV to increase automaticity and conduction respectively. If this fails, temporary pacing may be achieved either transcutaneously with sedation and analgesia or transvenously if facilities are available.