Population: Adults with bradycardia.

Organization

ACC/AHA/HRS 2018

Recommendations

–Consider evaluating for and treating sleep apnea if nocturnal bradycardia.

–Consider evaluating for structural heart disease including acute myocardial infarction.

–Evaluate for systemic conditions that may contribute such as medications (many antihypertensives, antiarrhythmics and psychoactive medications), rheumatologic conditions and inflammatory disorders, physical conditioning, carotid sinus hypersensitivity, syncope disorders, sleep, increased intracranial pressure, hypothyroidism, and sleep apnea.

–Give atropine for sinus node disease causing bradycardia with symptoms or hemodynamic instability.

–If bradycardia is caused by medication, use a reversal agent (10% calcium chloride or gluconate for calcium channel blocker overdose, glucagon or high-dose insulin for beta-blocker overdose, and digoxin antibody fragment for digoxin overdose).

–Use transcutaneous pacing for patients who remain hemodynamically unstable after medical therapy.

–Refer for pacemaker regardless of symptoms for second-degree Mobitz type II, high-grade AV block or third-degree AV block without reversible etiology.

–Refer for pacemaker if symptomatic from bradycardia with other etiologies that are not reversible.

–There is no minimum duration of pause that indicates the need for pacemaker, but rather the correlation between the pause and symptoms.

Source

–JACC. 2018;74(4):e51-e156.