Bradyarrhythmia Treatment

Introduction

Bradyarrhythmia refers to an abnormally slow heart rate, typically below 60 beats per minute. This condition can arise from issues with the sinoatrial (SA) node, atrioventricular (AV) node, or conduction pathways. While bradyarrhythmia may be asymptomatic in some cases, severe forms can lead to dizziness, fatigue, syncope, or even cardiac arrest.

Causes of Bradyarrhythmias

The most common causes include:

• Age-related degeneration of the heart's conduction system
• Medication side effects, such as beta-blockers or calcium channel blockers
• Electrolyte imbalances, particularly hyperkalemia or hypothyroidism
• Congenital heart disorders
• Ischemic heart disease, including myocardial infarction affecting the conduction system

When to Treat?

Not all cases of bradyarrhythmia require intervention. However, treatment is necessary if the patient exhibits symptoms such as:

• Persistent dizziness or syncope
• Hypotension
• Signs of heart failure
• Risk of asystole (cardiac standstill)

Treatment Options

1. Medication Adjustment

• If bradyarrhythmia is due to drug effects, discontinuation or adjustment of the medication may resolve the issue.
• Reversing underlying electrolyte imbalances or hypothyroidism is also crucial.

2. Pharmacological Therapy

• Atropine (first-line emergency treatment) – administered intravenously to increase heart rate.
• Isoproterenol or Dopamine – used in emergency situations when atropine is ineffective.

3. Pacemaker Implantation

For persistent or symptomatic bradyarrhythmia, a permanent pacemaker may be required. Indications include:

• Symptomatic sinus node dysfunction
• Advanced AV block (e.g., Mobitz type II or complete heart block)
• Chronic symptomatic bradycardia that does not respond to medication

Conclusion

Bradyarrhythmia treatment depends on the cause and severity of symptoms. Mild cases may only require monitoring, while symptomatic cases often need medical therapy or a pacemaker. Consultation with a cardiologist is essential for proper management.

Source recommendations

1. 2023 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000628
2. https://pubmed.ncbi.nlm.nih.gov/30412710/
3. https://www.hrsonline.org/guidance/clinical-resources
4. https://www.jacc.org/doi/abs/10.1016/j.jacc.2018.10.044
5. https://www.heartrhythmjournal.com/article/S1547-5271(23)02026-X/fulltext

2. 2021 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

1. https://academic.oup.com/eurheartj/article/42/35/3427/6358547
2. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Cardiac-Pacing-and-Cardiac-Resynchronization-Therapy
3. https://pubmed.ncbi.nlm.nih.gov/34455430/
4. https://www.heartrhythmjournal.com/article/S1547-5271(23)02026-X/fulltext
5. https://pubmed.ncbi.nlm.nih.gov/34455427/