{ "schemaVersion": 2, "eyebrow": "Cardiac Electrophysiology", "title": "Sinus Bradycardia", "summary": "Manage sinus bradycardia by first identifying hemodynamic compromise, documenting symptom-rhythm correlation, removing reversible causes, and reserving permanent pacing for clinically consequential sinus-node dysfunction rather than an isolated low heart rate.", "seoDescription": "Point-of-care approach to sinus bradycardia: stabilization, reversible causes, rhythm-symptom correlation, sleep apnea assessment, and pacing decisions.", "clinicalQuestion": "How should physicians stabilize, evaluate, and determine pacing need in adults with sinus bradycardia?", "specialty": "Cardiology", "audience": "U.S. physicians and medical trainees", "tags": [ "sinus bradycardia", "sinus node dysfunction", "sick sinus syndrome", "temporary pacing", "permanent pacemaker", "tachy-brady syndrome" ], "keyTakeaways": [ "Treat hypotension or other hemodynamic compromise from sinus bradycardia with immediate chronotropic support and pacing capability; transcutaneous pacing and inotropic support may be required as a bridge. [1][13]", "For suspected sinus-node dysfunction, establish a temporal relationship between bradycardia and symptoms before considering permanent pacing; symptomatic documented bradycardia is a pacing indication. [2][24]", "Review and correct reversible contributors first, particularly medications, metabolic derangements, sleep-disordered breathing, ischemic, inflammatory, infectious, toxic, and iatrogenic causes. [5][19][24]", "Nocturnal bradycardia should prompt sleep-apnea screening, but nocturnal bradycardia alone is not an indication for permanent pacing. [19]", "A permanent pacemaker is appropriate for symptomatic sinus-node dysfunction, chronotropic incompetence, or necessary drug therapy that produces clinically consequential sinus bradycardia. [24]" ], "sections": [ { "id": "initial-triage", "eyebrow": "Immediate management", "heading": "Identify bradycardia that requires urgent pacing support", "intro": "The immediate decision is whether the slow rate is causing inadequate perfusion.", "paragraphs": [ "Treat sinus bradycardia as unstable when it is accompanied by hypotension or other evidence of hemodynamic compromise. Obtain continuous ECG monitoring, establish pacing readiness, and correct immediately reversible precipitants while preparing temporizing therapy. Reported management of hemodynamically compromising sinus bradycardia has required inotropic support and transcutaneous pacing, with improvement in heart rate and hypotension. [1]", "Use transcutaneous pacing when rapid rate support is needed, particularly when drug treatment is ineffective or a reversible cause cannot be corrected promptly. Beta-adrenergic agonists, transcutaneous pacing, and temporary transvenous pacing are acute options for bradycardia; temporary transvenous pacing is also first-line therapy for bradycardia-dependent ventricular tachycardia. [13][20]", "Atropine can increase heart rate in sinus bradycardia; observational data cited in the ACC/AHA/HRS evidence supplement report effectiveness with 0.5 to 1 mg, but ventricular fibrillation, ventricular tachyarrhythmia, and sinus tachycardia occurred in some patients with acute myocardial infarction. Escalate rather than repeatedly delay pacing when clinical perfusion remains inadequate. [18]" ], "bullets": [ "Obtain a 12-lead ECG during the event to confirm sinus rhythm and identify coexisting AV block, ischemic changes, or wide-complex escape rhythm; conduction-system disease changes the urgency and long-term pacing assessment. [19][22]", "If recurrent prolonged pauses or profound bradycardia cause syncope despite correction of a reversible trigger, arrange urgent cardiology or electrophysiology evaluation for temporary versus permanent pacing strategy. [2][24]" ], "subsections": [], "table": { "caption": "Immediate management is determined by perfusion and response to temporizing measures. [1][13][18][20]", "columns": [ "Clinical state", "Immediate action", "Escalation trigger" ], "rows": [ [ "Sinus bradycardia with hypotension or hemodynamic compromise", "Continuous monitoring; initiate chronotropic support and transcutaneous pacing readiness. [1][13]", "Persistent compromise despite initial treatment warrants temporary pacing support. [1][13]" ], [ "Bradycardia-dependent ventricular tachycardia", "Use temporary pacing as first-choice therapy. [20]", "Continue pacing strategy while addressing the substrate causing bradycardia dependence. [20]" ], [ "Acute sinus bradycardia responsive to atropine", "Atropine 0.5-1 mg increased heart rate in cited observational data. [18]", "Monitor for tachyarrhythmia; move to pacing or beta-adrenergic agonist support if inadequate response or instability persists. [13][18]" ] ] } }, { "id": "confirm-clinical-significance", "eyebrow": "Diagnostic pivot", "heading": "Separate incidental sinus bradycardia from symptomatic sinus-node dysfunction", "intro": "Rate alone does not establish an indication for treatment.", "paragraphs": [ "The pivotal diagnostic task is to link symptoms to bradycardia or pauses. Fatigue, presyncope, syncope, and exercise intolerance become actionable when recorded concurrently with sinus bradycardia, sinus arrest, or failure of rate augmentation. Permanent pacing is indicated for symptomatic patients with documented bradycardia responsible for symptoms and for demonstrated chronotropic incompetence. [2][24]", "Evaluate for tachy-brady syndrome when atrial tachyarrhythmias alternate with sinus bradycardia or prolonged post-tachyarrhythmia pauses. This pattern is especially important when beta-blockers are required for atrial fibrillation but suppress sinus-node function, producing prolonged pauses and syncope after tachyarrhythmia termination; pacing can permit necessary therapy when the medication cannot be safely withdrawn. [24]", "Do not equate physiologic training-related sinus bradycardia with sinus-node disease. In athletes, sinus bradycardia may reflect exercise-induced electrical remodeling, increased vagal tone, and intrinsic changes in sinus automaticity and AV nodal function. Symptoms, abnormal chronotropic response, pathologic pauses, or nonphysiologic ECG findings should redirect evaluation toward sinus-node or conduction-system disease. [10]" ], "bullets": [ "Document the baseline ECG rhythm and compare it with prior tracings; new bradycardia after a medication change, procedure, ischemic event, or systemic illness favors an acquired and potentially reversible cause. [5][19]", "Use ambulatory rhythm monitoring when symptoms are intermittent and not captured on office ECG; monitoring is specifically recommended for bradycardia or sinus-node dysfunction in higher-risk adult congenital heart disease settings such as d-transposition of the great arteries after atrial switch. [6]", "Assess exercise-related symptoms for chronotropic incompetence; an abnormal rate response that corresponds to exertional limitation supports a pacing discussion even if resting bradycardia is not profound. [24]" ], "subsections": [], "table": { "caption": "Findings that change the interpretation of sinus bradycardia. [2][10][24]", "columns": [ "Pattern", "Interpretation", "Next action" ], "rows": [ [ "Asymptomatic sinus bradycardia in a highly trained athlete", "May reflect physiologic exercise-induced remodeling rather than sinus-node disease. [10]", "Assess for symptoms and nonphysiologic ECG or chronotropic findings before labeling sinus-node dysfunction. [10]" ], [ "Syncope or presyncope concurrent with documented sinus bradycardia or pause", "Supports symptomatic sinus-node dysfunction. [2][24]", "Exclude reversible causes, then evaluate for permanent pacing. [24]" ], [ "Atrial fibrillation treatment followed by prolonged pauses and syncope", "Suggests tachy-brady syndrome with medication-associated sinus-node suppression. [24]", "Determine whether the rate-slowing drug is necessary; pacing is appropriate when necessary therapy causes symptomatic bradycardia. [24]" ], [ "Exercise intolerance with chronotropic incompetence", "Supports clinically significant sinus-node dysfunction. [24]", "Consider permanent pacing after reversible contributors are addressed. [24]" ] ] } }, { "id": "reversible-causes", "eyebrow": "Etiologic branches", "heading": "Find and correct reversible causes before committing to a pacemaker", "intro": "Medication and systemic-cause review should occur during the initial evaluation, not after device referral.", "paragraphs": [ "Perform a directed medication reconciliation, including prescription agents, ophthalmic preparations, antiarrhythmics, and recent dose changes. The bradycardia guideline identifies medications as frequent culprits, and antiarrhythmic drugs can precipitate or worsen bradycardia in patients with sinus-node dysfunction or abnormal AV conduction. If a drug is nonessential, withhold or reduce it and reassess heart rate and symptoms. [5][8]", "Search for acquired contributors that alter management: metabolic derangements, ischemia, inflammatory or infiltrative disease, infection, toxic exposure, trauma, radiation, and iatrogenic injury are recognized causes of bradycardia and conduction disease. Direct testing to the clinical context—for example, targeted metabolic testing in an acutely ill patient, ischemic evaluation when symptoms or ECG suggest ischemia, and medication/toxin review after an exposure history—rather than assuming degenerative sinus-node disease. [19]", "Screen for sleep-disordered breathing when bradycardia is nocturnal or when the history suggests obstructive sleep apnea. Nocturnal bradycardias are common in sleep-disordered breathing and should prompt sleep-apnea assessment; they do not independently justify permanent pacing. [19]", "Age-related progressive fibrosis of the sinus node and adjacent atrial myocardium is a common substrate for sinus-node dysfunction. This diagnosis becomes more likely when symptomatic bradycardia persists after medication, systemic, sleep-related, ischemic, infectious, and iatrogenic contributors have been addressed. [19]" ], "bullets": [ "After changing a potentially causal medication, reassess both symptoms and rhythm before labeling the patient as having irreversible sinus-node dysfunction. [5][24]", "If antiarrhythmic or rate-control treatment remains necessary for another condition and causes symptomatic bradycardia, treat the competing indication explicitly; permanent pacing may be used to permit necessary therapy. [24]", "Do not implant a pacemaker solely for sleep-associated bradycardia without another pacing indication. [19]" ], "subsections": [], "table": { "caption": "Cause-directed evaluation of sinus bradycardia. [5][8][19][24]", "columns": [ "Etiologic branch", "Clue", "Action that changes management" ], "rows": [ [ "Medication-related bradycardia", "Temporal relation to a new agent, dose increase, or antiarrhythmic treatment. [5][8]", "Withdraw, reduce, or substitute a nonessential culprit; if the drug is necessary and bradycardia is symptomatic, evaluate for pacing. [24]" ], [ "Sleep-disordered breathing", "Predominantly nocturnal bradycardia. [19]", "Screen for sleep apnea; do not use nocturnal bradycardia alone as a pacing indication. [19]" ], [ "Systemic or acquired cardiac disease", "Metabolic, ischemic, inflammatory, infiltrative, infectious, toxic, radiation-related, traumatic, or iatrogenic context. [19]", "Pursue cause-specific evaluation and treatment before classifying sinus-node dysfunction as irreversible. [19][24]" ], [ "Progressive sinus-node fibrosis", "Persistent symptomatic syndrome after reversible contributors are addressed. [19]", "Document symptom-rhythm correlation and proceed to permanent-pacing assessment. [2][24]" ] ] } }, { "id": "permanent-pacing", "eyebrow": "Definitive therapy", "heading": "Select permanent pacing for symptomatic, nonreversible sinus-node dysfunction", "intro": "Permanent pacing treats clinically consequential bradycardia; it is not a treatment for an ECG finding alone.", "paragraphs": [ "Offer permanent pacemaker evaluation when symptoms are attributable to documented sinus bradycardia, sinus pauses, or chronotropic incompetence after reversible factors are corrected. Documented symptomatic bradycardia due to sinus-node dysfunction is a class I pacing indication in cited pacing guidance. [2][24]", "A second pacing pathway is medication necessity: when sinus-node dysfunction is worsened by medication required for another condition, particularly tachy-brady syndrome requiring beta-adrenergic blockade for atrial fibrillation, pacing may prevent prolonged post-conversion pauses and syncope while allowing treatment of the tachyarrhythmia. [24]", "For sinus-node dysfunction requiring a dual-chamber device, program to minimize unnecessary ventricular pacing. In the largest cited dual-chamber leadless pacemaker study, sinus-node dysfunction was the most common implant indication, accounting for 63.3% of implants; device choice should still be individualized to anatomy, anticipated pacing needs, AV conduction, and procedural considerations. [4][22]", "When syncope coexists with bifascicular block, do not assume isolated sinus-node dysfunction. After unrevealing noninvasive evaluation, electrophysiology study should be considered; pacing is indicated with a baseline His-ventricular interval of at least 70 ms, inducible second- or third-degree intra- or infra-Hisian block during incremental atrial pacing, or abnormal pharmacologic challenge response. Alternating bundle-branch block is itself an indication for pacing regardless of symptoms. [22]" ], "bullets": [ "Before implantation, record the symptom-rhythm correlation or documented chronotropic incompetence and verify that reversible causes have been addressed. [2][24]", "When AV conduction disease is suspected, broaden the device decision beyond sinus-node dysfunction and obtain electrophysiology input. [22]", "Avoid permanent pacing for isolated nocturnal bradycardia without another pacing indication. [19]" ], "subsections": [], "table": { "caption": "Pacing decisions in sinus bradycardia and related conduction findings. [2][19][22][24]", "columns": [ "Clinical finding", "Permanent pacing decision", "Important qualification" ], "rows": [ [ "Symptoms attributable to documented sinus bradycardia", "Indicated. [2][24]", "Correct reversible causes first. [24]" ], [ "Chronotropic incompetence with symptoms", "Indicated. [24]", "Establish that impaired rate response explains exertional limitation. [24]" ], [ "Necessary medication causing symptomatic sinus-node dysfunction", "Indicated when drug therapy is required for another condition. [24]", "Tachy-brady syndrome with required beta-blockade for atrial fibrillation is a typical setting. [24]" ], [ "Nocturnal bradycardia alone", "Not an indication. [19]", "Screen for sleep-disordered breathing. [19]" ], [ "Syncope with bifascicular block and abnormal electrophysiology study", "Indicated with His-ventricular interval at least 70 ms, inducible intra-/infra-Hisian block, or abnormal pharmacologic response. [22]", "Consider electrophysiology study after unexplained syncope despite noninvasive evaluation. [22]" ] ] } }, { "id": "follow-up-monitoring", "eyebrow": "Follow-up", "heading": "Monitor the clinical endpoint: symptoms, perfusion, and rhythm correlation", "intro": "The relevant outcome is prevention of recurrent hypoperfusion symptoms while avoiding unnecessary device therapy.", "paragraphs": [ "After withdrawal of a suspected culprit medication or treatment of an identified reversible factor, reassess symptoms and rhythm before proceeding to permanent pacing. A persistent temporal relationship between bradycardia and presyncope, syncope, fatigue, or exercise limitation favors intrinsic sinus-node dysfunction; resolution after cause-directed treatment favors a reversible diagnosis. [5][19][24]", "Patients with a pacemaker for sinus-node dysfunction should have programming reviewed to minimize unnecessary ventricular pacing when a dual-chamber device is used. This strategy is specifically recommended in ESC pacing guidance summarized by the ACC. [22]", "Reassess patients with atrial tachyarrhythmias for recurrent tachy-brady episodes after pacing and after changes in beta-blocker or antiarrhythmic therapy. Antiarrhythmics may worsen bradycardia in those with abnormal sinus-node or AV conduction, so rhythm-control decisions should be coordinated with the pacing plan. [8][24]" ], "bullets": [ "Escalate recurrent syncope, persistent hypotension, or symptomatic pauses to urgent rhythm evaluation and temporary pacing consideration when needed. [1][13][20]", "For nocturnal events, reassess sleep-disordered breathing rather than using overnight bradycardia alone to trigger device implantation. [19]" ], "subsections": [], "table": { "caption": "Follow-up targets after initial sinus-bradycardia management. [5][8][19][22][24]", "columns": [ "Scenario", "Monitor", "Action if unresolved" ], "rows": [ [ "Medication adjustment", "Symptoms and recurrence of documented bradycardia after dose reduction or withdrawal. [5][24]", "If medication is essential and bradycardia remains symptomatic, proceed to pacing assessment. [24]" ], [ "Nocturnal bradycardia", "Sleep-disordered breathing evaluation and persistence of clinically significant daytime symptoms. [19]", "Do not implant solely for nocturnal bradycardia; reassess for another pacing indication. [19]" ], [ "Dual-chamber pacemaker for sinus-node dysfunction", "Device programming and burden of unnecessary ventricular pacing. [22]", "Program to minimize unnecessary ventricular pacing. [22]" ], [ "Tachy-brady syndrome", "Post-tachyarrhythmia pauses, syncope, and bradycardic effect of required antiarrhythmics or beta-blockers. [8][24]", "Coordinate medication adjustment and pacing strategy. [24]" ] ] } } ], "faq": [], "references": [ { "number": 1, "title": "Sinus bradycardia with haemodynamic compromise following ...", "detail": "dtb.bmj.com", "url": "https://dtb.bmj.com/content/dtb/60/12/188.full.pdf", "authors": "dtb.bmj.com", "host": "dtb.bmj.com" }, { "number": 2, "title": "Cardiac Pacing | New England Journal of Medicine", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJM199601113340206", "authors": "www.nejm.org", "host": "www.nejm.org" }, { "number": 3, "title": "Ventricular Pacing or Dual-Chamber Pacing for Sinus-Node ...", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa013040", "authors": "www.nejm.org", "host": "www.nejm.org" }, { "number": 4, "title": "A Dual-Chamber Leadless Pacemaker | New England Journal of ...", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa2300080", "authors": "www.nejm.org", "host": "www.nejm.org" }, { "number": 5, "title": "2018 ACC/AHA/HRS Guideline on the Evaluation and Management ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIR.0000000000000628?doi=10.1161%2FCIR.0000000000000628", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 6, "title": "2025 ACC/AHA/HRS/ISACHD/SCAI Guideline for the Management ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIR.0000000000001402", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 7, "title": "Sleep-Disordered Breathing and Cardiac Arrhythmias in Adults", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIR.0000000000001082", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 8, "title": "2014 AHA/ACC/HRS Guideline for the Management of Patients With ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/cir.0000000000000041", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 9, "title": "2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2018.10.044", "authors": "www.jacc.org", "host": "www.jacc.org" }, { "number": 10, "title": "The Athlete’s ECG: Sport-Specific Patterns, Physiological Remodeling, and Clinical Interpretation", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacadv.2026.103153", "authors": "www.jacc.org", "host": "www.jacc.org" }, { "number": 11, "title": "2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2018.10.043", "authors": "www.jacc.org", "host": "www.jacc.org" }, { "number": 12, "title": "Standard Poster Abstracts for the 17th Asia Pacific Heart Rhythm ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1002/joa3.70004", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 13, "title": "[PDF] Pediatric antiarrhythmics and toxicity - Wiley Online Library", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/am-pdf/10.1002/emp2.13090", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 14, "title": "Predictors of pacemaker implantation within three... : Pacing and ...", "detail": "journals.lww.com", "url": "https://journals.lww.com/00006547-202307000-00028", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 15, "title": "Sick sinus syndrome : JAAPA - Ovid", "detail": "journals.lww.com", "url": "https://journals.lww.com/jaapa/fulltext/2017/07000/sick_sinus_syndrome.13.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 16, "title": "Perioperative management of hereditary arrhythmogenic syndromes", "detail": "www.bjanaesthesia.org", "url": "https://www.bjanaesthesia.org/article/S0007-0912(17)32221-3/fulltext", "authors": "www.bjanaesthesia.org", "host": "www.bjanaesthesia.org" }, { "number": 17, "title": "Perioperative management of patients with cardiac implantable ...", "detail": "www.bjanaesthesia.org", "url": "https://www.bjanaesthesia.org/article/S0007-0912(17)32552-7/fulltext", "authors": "www.bjanaesthesia.org", "host": "www.bjanaesthesia.org" }, { "number": 18, "title": "[PDF] Study Acronym; 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Sinus bradycardia with haemodynamic compromise following ...", "detail": "dtb.bmj.com", "url": "https://dtb.bmj.com/content/dtb/60/12/188.full.pdf", "authors": "dtb.bmj.com", "host": "dtb.bmj.com", "snippet": "The patient required temporary management with inotropic support and transcutaneous pacing. The patient's heart rate and hypotension improved in.", "score": 0.57006866 }, { "number": 2, "title": "Cardiac Pacing | New England Journal of Medicine", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJM199601113340206", "authors": "www.nejm.org", "host": "www.nejm.org", "snippet": "Documented symptomatic bradycardia due to sinus-node dysfunction is considered a class I indication for pacing, whereas documented bradycardia", "score": 0.4352539 }, { "number": 3, "title": "Ventricular Pacing or Dual-Chamber Pacing for Sinus-Node ...", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa013040", "authors": "www.nejm.org", "host": "www.nejm.org", "snippet": "The indication for pacemaker implantation was sinus-node dysfunction in all cases, but 21 percent of patients also had atrioventricular block. A total of", "score": 0.37291673 }, { "number": 4, "title": "A Dual-Chamber Leadless Pacemaker | New England Journal of ...", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa2300080", "authors": "www.nejm.org", "host": "www.nejm.org", "snippet": "The most common indications for dual-chamber pacemaker implantation were sinus-node dysfunction (190 patients [63.3%]) and atrioventricular", "score": 0.29495618 }, { "number": 5, "title": "2018 ACC/AHA/HRS Guideline on the Evaluation and Management ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIR.0000000000000628?doi=10.1161%2FCIR.0000000000000628", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "Patients may present with symptomatic sinus bradycardia attributable to reversible causes (Table 7).S5.4.2-1 Medications are frequent culprits.", "score": 0.8358192 }, { "number": 6, "title": "2025 ACC/AHA/HRS/ISACHD/SCAI Guideline for the Management ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIR.0000000000001402", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "Ambulatory monitoring for bradycardia or sinus node dysfunction is recommended for adults with d-TGA with atrial switch, especially if treated", "score": 0.70944256 }, { "number": 7, "title": "Sleep-Disordered Breathing and Cardiac Arrhythmias in Adults", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIR.0000000000001082", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the", "score": 0.6760432 }, { "number": 8, "title": "2014 AHA/ACC/HRS Guideline for the Management of Patients With ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/cir.0000000000000041", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "In general, antiarrhythmic drugs have the potential to precipitate or worsen bradycardia due to sinus node dysfunction or abnormal AV", "score": 0.6122407 }, { "number": 9, "title": "2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2018.10.044", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "Authors: Fred M.Kusumoto, MD, FACC, FAHA, FHRS, Mark H.Schoenfeld, MD, FACC, FAHA, FHRS, Coletta Barrett, RN, FAHA, James R.Edgerton, MD, FACC, FHRS, Kenneth A.Ellenbogen, MD, FACC, FAHA, FHRS, Michael R.Gold, MD, PhD, FACC, Nora F.Goldschlager, MD, FACC, FAHA, FHRS, … Show All …, Robert M.Hamilton,", "score": 0.9851 }, { "number": 10, "title": "The Athlete’s ECG: Sport-Specific Patterns, Physiological Remodeling, and Clinical Interpretation", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacadv.2026.103153", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "This state-of-the-art review examines sport-specific ECG patterns and how different training modalities influence cardiac electrical remodeling and its clinical interpretation. Many electrocardiogram (ECG) findings in athletes, including sinus bradycardia, early repolarization, and increased QRS vol", "score": 0.98297 }, { "number": 11, "title": "2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2018.10.043", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "Authors: Fred M.Kusumoto, MD, FACC, FAHA, FHRS, Mark H.Schoenfeld, MD, FACC, FAHA, FHRS, Coletta Barrett, RN, FAHA, James R.Edgerton, MD, FACC, FHRS, Kenneth A.Ellenbogen, MD, FACC, FAHA, FHRS, Michael R.Gold, MD, PhD, FACC, Nora F.Goldschlager, MD, FACC, FAHA, FHRS, … Show All …, Robert M.Hamilton,", "score": 0.98271 }, { "number": 12, "title": "Standard Poster Abstracts for the 17th Asia Pacific Heart Rhythm ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1002/joa3.70004", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "## USEFULLNESS OF HDGC (HIGH DENSITY GRID CATHETER) FOR VT STORM ABLATION. **Introduction:** In VT ablation, evaluation of contact bipolar potential during VT and sinus rhythm is extremely important. This time, we report a case in which bipolar blindness in an ablation catheter was successfully cove", "score": 0.95723 }, { "number": 13, "title": "[PDF] Pediatric antiarrhythmics and toxicity - Wiley Online Library", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/am-pdf/10.1002/emp2.13090", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "In the acute setting, bradycardia is treated with beta-adrenergic agonists, transcutaneous pacing, or temporary transvenous pacing.", "score": 0.42935818 }, { "number": 14, "title": "Predictors of pacemaker implantation within three... : Pacing and ...", "detail": "journals.lww.com", "url": "https://journals.lww.com/00006547-202307000-00028", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "While much progress has been made, some patients require implantation of a temporary or permanent pacemaker due to severe sinus bradycardia, sinus arrest,", "score": 0.26389736 }, { "number": 15, "title": "Sick sinus syndrome : JAAPA - Ovid", "detail": "journals.lww.com", "url": "https://journals.lww.com/jaapa/fulltext/2017/07000/sick_sinus_syndrome.13.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Severe symptomatic bradycardia due to sinus node dysfunction implies failure of these escape mechanisms, in addition to the sinus node dysfunction itself.", "score": 0.65887916 }, { "number": 16, "title": "Perioperative management of hereditary arrhythmogenic syndromes", "detail": "www.bjanaesthesia.org", "url": "https://www.bjanaesthesia.org/article/S0007-0912(17)32221-3/fulltext", "authors": "www.bjanaesthesia.org", "host": "www.bjanaesthesia.org", "snippet": "In congenital sick sinus syndrome, severe bradycardia resistant to atropine may require isoproterenol or epinephrine. bradycardia Atropine; transcutaneous", "score": 0.6122407 }, { "number": 17, "title": "Perioperative management of patients with cardiac implantable ...", "detail": "www.bjanaesthesia.org", "url": "https://www.bjanaesthesia.org/article/S0007-0912(17)32552-7/fulltext", "authors": "www.bjanaesthesia.org", "host": "www.bjanaesthesia.org", "snippet": "The most common indications for pacing currently include: symptomatic bradycardia (including that resulting from sinus node dysfunction), atrioventricular (AV)", "score": 0.48103997 }, { "number": 18, "title": "[PDF] Study Acronym; - American College of Cardiology", "detail": "jaccjacc.acc.org", "url": "http://jaccjacc.acc.org/Clinical_Document/Bradycardia_GL_Online_Data_Supplement.pdf?__hstc=117268889.e70edc27b86939bdf48f259dd57ad589.1787443200538.1787443200539.1787443200540.1&__hssc=117268889.1.1787443200541&__hsfp=616a8fc2acf33499458b9b81246a7d90", "authors": "jaccjacc.acc.org", "host": "jaccjacc.acc.org", "snippet": "Inc., and the Heart Rhythm Society. Ventricular fibrillation occurred in 1/45 pts treated with atropine, and 2/45 pts not treated with atropine. Atropine at a dose of 0.5–1 mg was effective in increasing heart rate. Scheinman MM, et al. 1975 (82) 1157275 Study type: Observational, single center Size", "score": 0.45769477 }, { "number": 19, "title": "New in Clinical Documents | New Guideline Outlines Recommendations For Evaluating Managing Bradycardia - American College of Cardiology", "detail": "www.acc.org", "url": "https://www.acc.org/latest-in-cardiology/articles/2018/11/06/12/42/new-in-clinical-documents-new-guideline-outlines-recommendations-for-evaluating-managing-bradycardia", "authors": "www.acc.org", "host": "www.acc.org", "snippet": "The guideline pays particular attention to indications for temporary and permanent pacing. For example, with sleep disorders of breathing and nocturnal bradycardias both relatively common, the guideline suggests the presence of nocturnal bradycardias is not in itself an indication for permanent paci", "score": 0.34092444 }, { "number": 20, "title": "Temporary Transvenous Cardiac Pacing in the Critical Care Setting", "detail": "journal.chestnet.org", "url": "https://journal.chestnet.org/article/S0012-3692(16)30341-5/fulltext", "authors": "journal.chestnet.org", "host": "journal.chestnet.org", "snippet": "Temporary pacing is the therapy of first choice in managing patients with bradycardia-dependent ventricular tachycardia. Atrial pacing is recommended,", "score": 0.3058222 }, { "number": 21, "title": "Bradycardia Guideline Hub | Journal of the American College of Cardiology", "detail": "www.acc.org", "url": "https://www.acc.org/Guidelines/Hubs/Bradycardia-and-Cardiac-Conduction-Delay", "authors": "www.acc.org", "host": "www.acc.org", "snippet": "Free Access ##### Pacing as a Treatment for Reflex-Mediated (Vasovagal, Situational, or Carotid Sinus Hypersensitivity) Syncope: A Systematic Review for the 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American ", "score": 0.19132802 }, { "number": 22, "title": "2021 ESC Guidelines on Cardiac Pacing and CRT: Key Points - American College of Cardiology", "detail": "www.acc.org", "url": "https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2021/08/31/18/37/2021-esc-guidelines-on-cardiac-pacing-esc-2021", "authors": "www.acc.org", "host": "www.acc.org", "snippet": "6. In patients with sinus node dysfunction and a DDD pacemaker, minimization of unnecessary ventricular pacing through programming is recommended.\n7. Conduction system pacing (which includes His bundle and left bundle branch area pacing) is very likely to play a growing role in the future, pending r", "score": 0.19042309 }, { "number": 23, "title": "TUESDAY • OCTOBER 26, 1993 - CHEST", "detail": "journal.chestnet.org", "url": "https://journal.chestnet.org/article/S0012-3692(16)61342-9/fulltext", "authors": "journal.chestnet.org", "host": "journal.chestnet.org", "snippet": "Hypoxomia contributed to 10 cardiac arrests and 19 episodes of symptomatic bradycardia requiring atropine. Regurgitation of stomach contents (55, 5.3%)", "score": 0.18871276 }, { "number": 24, "title": "Sick Sinus Syndrome - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/sites/books/NBK470599", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "The management of sinus node dysfunction includes identifying and correcting reversible factors, as an initial step. After treating reversible causes, the treatment of sinus node dysfunction can include the placement of a permanent pacemaker. A permanent pacemaker is indicated in symptomatic patient", "score": 0.88444936 } ], "publishedAt": "2026-09-15T22:57:26.087637+00:00", "updatedAt": "2026-09-15T22:57:26.087637+00:00", "readingMinutes": 6, "slug": "sinus-bradycardia" }