Management of bradyarrhythmias

ABSTRACT

BRADYCARDIAS, defined as a heart rate less than 60 beats/min are encountered frequently in clinical practice. The two main categories of bradycardia are related to dysfunction of the sinus node and atrioventricular [AV] conduction. The usual symptoms of bradycardia include dizziness, lightheadedness, fatigue, worsening of congestive failure, near syncope, and syncope. However, rates below 60 beats/min are not uncommon in asymptomatic individuals. Therefore, when patients experience the above-described symptoms and bradycardia is documented, it is crucial to prove that the bradycardia is the underlying cause. Otherwise, treatment of the bradycardia may not relieve patients symptoms. It is also not uncommon to see patients with symptoms of bradycardia who have no documentation of sinus node dysfunction [SND] or AV block. In these settings, therefore, further work-up is often necessary to reveal the underlying etiology for observed symptoms. The purpose of this communication is to discuss the approach towards the diagnosis and management of bradycardia in these clinical settings