title: Compromising bradycardia: management in the emergency department.
abstract: OBJECTIVE
  Bradycardia may represent a serious emergency. The need for temporary and permanent pacing is unknown.
  
  
  METHODS
  We analysed a registry for the incidence, symptoms, presenting rhythm, underlying mechanism, management and outcome of patients presenting with compromising bradycardia to the emergency department of a university hospital retrospectively during a 10-year period.
  
  
  RESULTS
  We identified 277 patients, 173 male (62%), median age 68 (IQR 58-78), median ventricular rate 33 min(-1) (IQR 30-40). The leading symptoms were syncope [94 (33%)], dizziness [61 (22%)], collapse [46 (17%)], angina [46 (17%)] and dyspnoea/heart failure [30 (11%)]. The initial ECG showed high grade AV block [134 (48%)], sinus bradycardia/AV block [46 (17%)], sinuatrial arrest [42 (15%)], bradycardic atrial fibrillation [39 (14%)] and pacemaker-failure [16 (6%)]. The underlying mechanisms were primary disturbance of cardiac automaticity and/or conduction [135 (49%)], adverse drug effect [58 (21%)], acute myocardial infarction [40 (14%)], pacemaker failure [16 (6%)], intoxication [16 (6%)] and electrolyte disorder [12 patients (4%)]. In 107 (39%) patients bed rest resolved the symptoms. Intravenous drugs to increase ventricular rate were given to 170 (61%) patients, 54 (20%) required additional temporary transvenous/transcutaneous pacing. Two severely intoxicated patients could be stabilised only by cardiopulmonary bypass. A permanent pacemaker was implanted in 137 patients (50%). Mortality was 5% at 30 days.
  
  
  CONCLUSIONS
  In our cohort, about 20% of the patients presenting with compromising bradycardia required temporary emergency pacing for initial stabilisation, in 50% permanent pacing had to be established.
authors.affiliation: Department of Emergency Medicine, Vienna General Hospital, Medical School, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: G H
authors.initials: GH
authors.lastname: Sodeck
authors.forename: H
authors.initials: H
authors.lastname: Domanovits
authors.forename: G
authors.initials: G
authors.lastname: Meron
authors.forename: F
authors.initials: F
authors.lastname: Rauscha
authors.forename: H
authors.initials: H
authors.lastname: Losert
authors.forename: M
authors.initials: M
authors.lastname: Thalmann
authors.forename: M
authors.initials: M
authors.lastname: Vlcek
authors.forename: A N
authors.initials: AN
authors.lastname: Laggner
mesh_terms: D000368:Aged; D000435:Alcoholic Intoxication / Q000150:complications; D000787:Angina Pectoris / Q000209:etiology; D001145:Arrhythmias, Cardiac / Q000150:complications; D001281:Atrial Fibrillation / Q000175:diagnosis; D001510:Bed Rest; D001919:Bradycardia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000009:adverse effects; D004244:Dizziness / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D004868:Equipment Failure; D005260:Female; D006327:Heart Block / Q000175:diagnosis; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D010138:Pacemaker, Artificial / Q000009:adverse effects; D012042:Registries; D012189:Retrospective Studies; D013575:Syncope / Q000209:etiology; D014883:Water-Electrolyte Imbalance / Q000150:complications
chemical_list: D002316:Cardiotonic Agents