Evaluating and managing bradycardia

Trends Cardiovasc Med. 2020 Jul;30(5):265-272. doi: 10.1016/j.tcm.2019.07.001. Epub 2019 Jul 9.


Bradycardia is a commonly observed arrhythmia and a frequent occasion for cardiac consultation. Defined as a heart rate of less than 50-60 bpm, bradycardia can be observed as a normal phenomenon in young athletic individuals, and in patients as part of normal aging or disease (Table 1). Pathology that produces bradycardia may occur within the sinus node, atrioventricular (AV) nodal tissue, and the specialized His-Purkinje conduction system. Given the overlap of heart rate ranges with non-pathologic changes, assessment of symptoms is a critical component in the evaluation and management of bradycardia. Treatment should rarely be prescribed solely on the basis of a heart rate lower than an arbitrary cutoff or a pause above certain duration. In the 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay (referred to hereafter as the 2018 Bradycardia Guideline), there was a significant shift in emphasis from prior guidelines that emphasized device-based implantation recommendations to a focus on evaluation and management of disease states [1,2]. In this review, we will highlight the changes in the new guideline as well as describe the key elements in evaluation and management of patients presenting with bradycardia.

Publication types

  • Review

MeSH terms

  • Action Potentials
  • Atrioventricular Block / diagnosis
  • Atrioventricular Block / physiopathology
  • Atrioventricular Block / therapy*
  • Bradycardia / diagnosis
  • Bradycardia / physiopathology
  • Bradycardia / therapy*
  • Cardiac Pacing, Artificial* / adverse effects
  • Clinical Decision-Making
  • Heart Conduction System / physiopathology*
  • Heart Rate*
  • Humans
  • Pacemaker, Artificial*
  • Patient Selection
  • Sick Sinus Syndrome / diagnosis
  • Sick Sinus Syndrome / physiopathology
  • Sick Sinus Syndrome / therapy*
  • Treatment Outcome