Management of acute bradyarrhythmias

Writing Committee Members, 2019

In patients with an acute bradyarrhythmia, check for and manage possible causes of bradyarrhythmia, such as raised intracranial pressure, drugs, coronary artery disease, hyperkalaemia or hypothermia.

Acute bradyarrhythmia should only be treated if it causes significant haemodynamic compromise with signs of poor perfusion, which can lead to hypotension and syncope, altered conscious state, ischaemic chest pain and heart failure. Use chronotropic drugs (eg isoprenaline, adrenaline [epinephrine]) with caution because they can provoke serious ventricular arrhythmias.

During evaluation and management of a patient with an acute bradyarrhythmia:

• maintain a patent airway and assist breathing as needed
• give oxygen, if appropriate, and monitor using pulse oximetry
• use a 12-lead electrocardiogram (ECG) to monitor and identify heart rhythm
• monitor blood pressure
• establish intravenous access
• prepare for transcutaneous pacing.

In an emergency setting, for a patient with acute bradycardia causing severe haemodynamic compromise, transcutaneous pacing may be required as a temporary measure until transvenous pacing is feasible.