From the Research
Symptomatic bradycardia treatment should prioritize transcutaneous cardiac pacing (TCP) as a first-line therapy, especially in patients who are unresponsive to atropine, as it has been shown to be a clinically effective treatment modality in patients with atropine-resistant unstable bradycardia 1. When managing symptomatic bradycardia, it is essential to consider the underlying cause and the patient's symptoms.
- The 2020 study published in Clinical Medicine & Research found that early permanent pacemaker (PPM) implantation was not associated with an increase in adverse events compared to delayed PPM implantation 2.
- However, the 2022 case report published in the British Paramedic Journal highlighted the potential for paradoxical worsening of bradycardia following atropine administration, particularly in patients with infranodal atrioventricular blocks 3.
- The 2020 review published in Trends in Cardiovascular Medicine emphasized the importance of evaluating and managing bradycardia based on symptoms and underlying disease states, rather than solely on heart rate 4.
- In terms of specific treatment, TCP has been shown to be effective in increasing heart rate and improving blood pressure in patients with symptomatic bradycardia, with a significant difference in mean systolic and diastolic blood pressure and median heart rate before and after TCP administration 1.
- Additionally, the use of algorithms that act in the atrium for preventive pacing and atrial antitachycardia pacing while minimizing right ventricular pacing may be beneficial in patients with sinus node disease and previous atrial tachyarrhythmias 5.