How Can I Manage Bradycardia?
Once bradycardia has been determined to be abnormal, its management and treatment depend wholly on the type of bradycardia and what is causing it and any symptoms or dangers associated with the resulting ventricular rate.
Sick Sinus Syndrome (SSS)
If unstable, an SSS patient should undergo advanced life support protocols with transcutaneous pace making, atropine (anticholinergic), and/or dopamine, epinephrine, or isoproterenol for hypotension. Once stabilized, the treatment is the same as for any stable SSS patient:
- Identify any reversible causes (medication, electrolyte, or autonomic nervous system imbalance)
- Address any cardiac ischemia
- Implantation of a permanent pacemaker if symptomatic, with a consideration for anticoagulation due to the increased risk of atrial fibrillation and thromboembolism seen in pacemaker patients
- Pharmacologic therapy
Symptomatic Sinus Bradycardia
- If unstable, a patient with bradycardia should undergo pharmacologic therapy (atropine, anticholinergic) and application of a transcutaneous pacemaker
- If stable, look for and treat any reversible causes, such as hypothyroidism, infection, or replacement of any medication(s) suspected of causing the bradyarrhythmia
- Treat any heart blocks with a pacemaker
Other Heart Disease
Other heart disease that results in bradycardia, such as previous infarction, ischemia, coronary artery disease, or congenital causes are treated primarily via supportive measures, with a pacemaker if symptoms warrant and it is not otherwise contraindicated.