![]() ![]() Transcutaneous pacing is only indicated until a permanent pacemaker can be implemented. Most modern defibrillators are equipped with ability to perform transcutaneous pacing. (3) If atropine and isoproterenol fails, it might be necessary to perform transcutaneous pacing (external pacing. This is titrated up until adequate effect is achieved. An ampoule with 5 ml (0,2 mg/ml) isoproterenol is mixed with 245 ml glucose (50 mg/ml) with starting dose 0,01 μg/kg/min. (2) If atropine is insufficient or require too frequent dosing, infusion isoproterenol should be given. In case of acute bradycardia with circulatory compromise: (1) 1–2 ml of atropine 0.5 mg/ml is the first line therapy.Terminate or adjust any medications that cause or aggravate the bradycardia. ![]() It is very common that patients with bradycardia have a strong indication for drugs that aggravate or even cause the bradycardia in such scenarios, it is generally considered to be evidence based to implement an artificial pacemaker that will allow for drug therapy to continue.īradycardia (of any cause) may be treated according to the following algorithm: If drug side effects are believed to be the cause, it is fundamental to weight the risk of terminating drug therapy as compared with implementing an artificial pacemaker in order to be able to continue drug therapy. When in doubt whether the bradycardia is physiological, it is useful to perform a Holter ECG (ambulatory recording). Treatment of bradycardia (due to any cause)īenign (physiological) causes of bradycardia (e.g vasovagal reaction, well-trained athletes) need not be treated. Pacemaker treatment is discussed in a separate article. Moreover, it is still debated whether the transient periods of atrial standstill in sinus bradycadia is associated with an increased risk of thromboembolism. However, it should be noted that any bradycardia originating in the sinoatrial node is unlikely to lead to premature death. Persons with sick sinus syndrome should receive an artificial pacemaker in order to reduce symptoms and increase function. In case of concomitant tachyarrhythmia, the pacemaker allows for adequate (high) dosing of rate controlling drugs (e.g beta-blockers) without the risk of worsening the bradycardia. Implementation of an external artificial pacemaker is an effective treatment. Sick sinus syndrome is, if caused by irreversible conditions, a progressive disease which necessitates treatment. Treatment of sick sinus syndrome and bradycardia in general The condition in which sinus node dysfunction is accompanied by supraventricular tachyarrhythmia is referred to as tachy-brady syndrome, because these individuals are affected by bradycardia as well as tachycardia. Sinus node dysfunction is also associated with a high risk of developing supraventricular tachyarrhythmias, especially atrial fibrillation and atrial flutter. Risk of supraventricular tachyarrhythmia (tachycardia)
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