Sinus Bradycardia Treatment & Management

Updated: Nov 21, 2016
  • Author: Mark W Livingston, MD; Chief Editor: Erik D Schraga, MD  more...
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Treatment

Prehospital Care

Intravenous access, supplemental oxygen, and cardiac monitoring should be initiated in the field.

In symptomatic patients, intravenous atropine may be used.

In rare cases, transcutaneous pacing may need to be initiated in the field.

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Emergency Department Care

Care in the ED should first rapidly ensure the stability of the patient's condition. This is followed by an investigation into the underlying cause of the bradycardia.

Patients in unstable condition may require immediate endotracheal intubation and transcutaneous or transvenous pacing.

Patients should have continuous cardiac monitoring and intravenous access.

In hemodynamically stable patients, attention should be directed at the underlying cause of the bradycardia.

In sick sinus syndrome, drug therapy approaches have been relatively disappointing. While atropine has aided some patients transiently, most patients ultimately require placement of a pacemaker. Guidelines on permanent pacing are available from the American College of Cardiology/American Heart Association/Heart Rhythm Society, [6] as well as from the European Society of Cardiology (ESC), in association with the European Heart Rhythm Association. [7]

The ESC guidelines state that in adults with acquired persistent bradycardia, pacing is indicated if a patient displays symptoms that are clearly caused by sinus bradycardia; moreover, pacing may be indicated in the presence of symptoms that, despite inconclusive evidence, are probably the result of sinus bradycardia. If sinus bradycardia is asymptomatic or produced by a reversible cause, according to the guidelines, pacing is not indicated. [7]

In patients with sinus bradycardia secondary to therapeutic use of digitalis, beta-blockers, or calcium channel blockers, simple discontinuation of the drug, along with monitored observation, are often all that is necessary. Occasionally, intravenous atropine and temporary pacing are required.

Treatment of postinfectious bradycardia usually requires permanent pacing.

In patients with hypothermia who have confirmed sinus bradycardia with a pulse, atropine and pacing are usually not recommended because of myocardial irritability. Rewarming and supportive measures are the mainstays of therapy.

Sinus bradycardia may be seen in patients undergoing therapeutic hypothermia. [8] These patients are likely to develop sinus bradycardia sometime during their course that will require close monitoring of perfusion status. If they show signs of adequate perfusion, no treatment is necessary. Treatment of inadequate perfusion would include pressors, atropine, and pacing. [9]

Sleep apnea is usually treated with weight loss, nasal bilevel positive airway pressure (BiPAP) and, occasionally, surgery.

Inpatient care

Once the patient's condition is stabilized, inpatient care must be tailored to the inciting cause of the dysrhythmia.

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Long-Term Monitoring

Outpatient follow-up care is dependent on the underlying cause of the bradycardia.

Most patients should be able to follow up with their primary care provider or obtain a referral for a follow-up visit.

Some patients may require specialized referral to a cardiologist. Arrange prompt follow-up care in patients with symptomatic sinus bradycardia.

Regular follow-up care is necessary for patients in whom a permanent pacemaker is placed.

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