Therapeutic target
Restoration of a normal heart rate
Therapy recommendations
- Asymptomatic sinus bradycardia does not require drug therapy!
- In the case of bradycardia, drug therapy is given only in an emergency:
- Atropine (parasympatholytics) in symptomatic but hemodynamically still compensated bradycardia of suprahisic origin (sinus bradycardia, AV block II° Wenckebach type).
- Epinephrine (agent of last choice) in the case of
- Insufficient increase in frequency after atropine administration or
- Asystole requiring resuscitation
Therapy recommendations for bradycardia symptoms on medication that can induce arrhythmias:
- Dose reduction or discontinuation of the drug if it is not indispensable or cannot be replaced.
- In case of overdose, activated charcoal or gastric lavage may be useful if necessary.
- Short-term atropine 0.5 mg i.v. every 3 to 5 minutes up to max dose of 3 mg can bring improvement (Cave!: Not in patients after heart transplantation!).
- Close-meshed control of electrolytes; if necessary, also dextrose i. v.
- Hemodynamic impairment: Isoproterenol, dopamine, dobutamine, or epinephrine (this medication only if there is a low probability of coronary ischemia).
- Hemodynamic unstable bradycardia because of:
- Overdose with beta blockers or calcium channel blockers:
- Overdose of AV node-blocking drugs resulting in refractory bradyarrhythmias:
- Insulin (1 unit/kg as an i.v. bolus, followed by infusion at 0.5 units/kg/hour
Further notes
- Infants with bradycardia and poor perfusion who underwent cardiopulmonary resuscitation had a worse prognosis with epinephrine therapy (21% more deaths).Note: Infant cardiac output is determined primarily by pulse rather than by cardiac output (SV). This may limit the benefit of epinephrine therapy.
