5th May 2025

Mrs Patel is admitted to the Orthopaedic ward following a fall whereby she sustained a right neck of femur fracture.

Mrs Patel is admitted to the Orthopaedic ward following a fall whereby she sustained a right neck of femur fracture. She underwent a right hip hemiarthroplasty and is transferred to the ward from recovery. Whilst on the ward, she develops a run of fast atrial fibrillation with a rate of 140 beats per minute; this settles after some IV fluids. The diligent Orthopaedic team arrange for an inpatient 48-Hour Holter monitor which shows periods of sinus pause, the longest being 4.2 seconds. You are called to assess her as the medical registrar on duty as she develops a sudden bradycardic episode with a heart rate of 35 beats per minute; you note normal heart sounds and a euvolaemic patient. Repeat 12-lead ECG at the bedside shows sinus rhythm with a rate of 60 beats per minute. Given the likely diagnosis, what is the next most appropriate step in the management of this patient?

Select the SINGLE most appropriate option from the list below. Select ONE option only.