Surgical Critical Care: Bradyarrhythmia

Pharmacology/Medication Dosing

• *See Surgical Critical Care: Antiarrhythmic Pharmacology

Sinus Bradycardia

• EKG Pattern:
  • HR < 50-60 bpm
  • Normal P Waves
• Primary Treatment: Nothing
• Atropine Indications:
  • Hemodynamic Instability
  • Signs of Shock
  • Ischemic Chest Discomfort
  • Acute Heart Failure
  • Acute Altered Mental Status
• If Atropine Fails: Dopamine or Epinephrine Infusion
  • Also Consider Transcutaneous or Transvenous Pacing

First Degree AV Block

• EKG Pattern:
  • Prolonged PR Interval > 200 ms
  • No Interruption in AV Conduction
• Treatment: Nothing

Second Degree AV Block – Mobitz Type I (Wenkebach)

• EKG Pattern:
  • Progressive PR Interval Prolongation Followed by Dropped Beats
• Treatment:
  • Stable: Nothing
  • Unstable: Atropine

Second Degree AV Block – Mobitz Type II

• EKG Pattern:
  • Normal PR Interval (120-200 ms)
  • Sudden Dropped Beats
• Treatment:
  • Stable: Pacemaker (Transcutaneous or Permanent if Persistent)
  • Unstable: Atropine
    • If Fails: Dopamine or Dobutamine Infusion

Third Degree (Complete) AV Block

• EKG Pattern:
  • P Wave and QRS Complex Completely Independent
• Treatment:
  • Stable: Pacemaker (Transcutaneous or Permanent if Persistent)
  • Unstable: Atropine
    • If Fails: Dopamine or Dobutamine Infusion