5th May 2025

Overview

Bradyarrhythmias are heart rhythms with a ventricular rate below 60 beats per minute. Bradyarrhythmias can be physiological (e.g. in athletes or during sleep) or pathological – commonly due to conduction pathway abnormalities or sinoatrial / atrioventricular nodal disease. Clinical manifestations of bradyarrhythmias can range from mild symptoms such as lethargy and exertional dyspnoea, to frank syncope. Up to 40% of patients report a syncopal episode with bradycardia, which is recurring in just over 10% of patients. In the elderly, bradyarrhythmias are a common cause of falls and are a common reason for pacemaker insertion. There is an increased risk of sudden cardiac death due to loss of cardiac output or asystole. Early detection of bradyarrhythmias in patients (ideally, when asymptomatic) is crucial to effective intervention – both in the acute and chronic settings. In this chapter we will look at some common cardiac causes of bradyarrhythmias and their specific management.