Bradyarrhythmias

Watch ▶Approach to bradycardia: Clinical sciences

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Atrial Bradyarrhythmias Overview

Type of Bradyarrhythmia Causes and Mechanisms Main ECG Findings
Sinus Bradycardia 🔷 Physiological, particularly in athletes
🔷 Sinus node dysfunction (see sick sinus syndrome)
🔷 Drugs ⇒ beta blockers, calcium channel blockers 🔷 Rate < 60 bpm
🔷 Normal P wave before every QRS complex
Tachycardia-Bradycardia Syndrome 🔷 Abnormal supraventricular impulse generation and conduction
🔷 See sick sinus syndrome for details 🔷 Intermittent tachyarrhythmias and bradyarrhythmias
Respiratory Sinus Arrhythmia 🔷 Physiological, particularly in youths (A natural variation of the heart rate during respiration) 🔷 Minor changes in the R-R interval during respiration ⇒ reduction during inspiration and increase during expiration
Sinus Pause or Arrest 🔷 May occur in healthy individuals
🔷 Underlying cardiovascular disease (see sick sinus syndrome) 🔷 Transient (sinus pause) or complete (sinus arrest) absence of the P wave

Sinus Bradycardia

Causes

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Severe bradycardia and AV block during laparoscopy directly after Co2 insufflation is due to peritoneal stretching → Vagal stimulation → ↓↓ HR

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Clinical Presentation

Diagnosis

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[A] Sinus bradycardia

[A] Sinus bradycardia

Management

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Sick Sinus Syndrome

General

Etiology

Sinus bradycardia with sinus pause and junctional escape rhythm

Sinus bradycardia with sinus pause and junctional escape rhythm

Clinical Presentation

Diagnosis

<aside> 💡 Preferred initial diagnostic study ⇒ 12-lead ECG

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Chronotropic incompetence

Management

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[A]

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[B]

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[C]

Atrioventricular Block