Treatment of bradyarrhythmias

Hypoxaemia must be corrected in all symptomatic bradycardias. First line drug treatment is usually atropine 0.3mg or glycopyrrolate 200pg intravenously. If the arrhythmia fails to respond, 0.6mg followed by 1.0mg atropine may be given. Failure to respond to drugs requires temporary pacing. This may be accomplished rapidly with an external system if there is haemodynamic compromise or transvenously. Other indications for temporary pacing are shown opposite. Higher degrees of heart block after an anterior myocardial infarction will usually require permanent pacing.

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