title: Evaluation and management of bradycardia in neonates and children.
abstract: Heart rate is commonly used in pediatric early warning scores. Age-related changes in the anatomy and physiology of infants and children produce normal ranges for electrocardiogram features that differ from adults and vary with age. Bradycardia is defined as a heart rate below the lowest normal value for age. Pediatric bradycardia most commonly manifests as sinus bradycardia, junctional bradycardia, or atrioventricular block. As a result of several different etiologies, it may occur in an entirely structurally normal heart or in association with concomitant congenital heart disease. Genetic variants in multiple genes have been described to date in the pathogenesis of inherited sinus node dysfunction or progressive cardiac conduction disorders. Management and eventual prognosis of bradycardia in the young are entirely dependent upon the underlying cause. Reasons to intervene for bradycardia are the association of related symptoms and/or the downstream risk of heart failure or pause-dependent tachyarrhythmia. The simplest aspect of severe bradycardia management is reflected in the Pediatric and Advanced Life Support (PALS) guidelines.
  
  
  CONCLUSIONS
  Early diagnosis and appropriate management are critical in many cases in order to prevent sudden death, and this review critically assesses our current practice for evaluation and management of bradycardia in neonates and children.
  
  
  BACKGROUND
  Bradycardia is defined as a heart rate below the lowest normal value for age. Age related changes in the anatomy and physiology of infants and children produce normal ranges for electrocardiogram features that differ from adults and vary with age. Pediatric bradycardia most commonly manifests as sinus bradycardia, junctional bradycardia, or atrioventricular block.
  
  
  BACKGROUND
  Management and eventual prognosis of bradycardia in the young are entirely dependent upon the underlying cause. Bradycardia may occur in a structurally normal heart or in association with congenital heart disease. Genetic variants in multiple genes have been described. Reasons to intervene for bradycardia are the association of related symptoms and/or the downstream risk of heart failure or pause-dependent tachyarrhythmia. Early diagnosis and appropriate management are critical in order to prevent sudden death.
authors.affiliation: Morgan Stanley Children's Hospital, Division of Pediatric Cardiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA. alban.baruteau@gmail.com.|LIRYC Institute (Electrophysiology and Heart Modeling Institute), Division of Pediatric Cardiology, Hôpital Cardiologique du Haut Lévèque, Bordeaux-2 University, Bordeaux, France. alban.baruteau@gmail.com.|L'Institut du Thorax, INSERM UMR1087, CNRS UMR6291, Nantes University, Nantes, France. alban.baruteau@gmail.com.|Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, New York Presbyterian / Columbia University Medical Center, 3959 Broadway, New York, NY, 10032, USA. alban.baruteau@gmail.com.
authors.forename: Alban-Elouen
authors.initials: AE
authors.lastname: Baruteau
authors.affiliation: Rady Children's Hospital, Department of Pediatrics, Division of Cardiology, University of California, San Diego, San Diego, CA, USA. jperry@rchsd.org.
authors.forename: James C
authors.initials: JC
authors.lastname: Perry
authors.affiliation: British Columbia Children's Hospital, Department of Pediatric Cardiology, University of British Columbia, Vancouver, BC, Canada. ssanatani@cw.bc.ca.
authors.forename: Shubhayan
authors.initials: S
authors.lastname: Sanatani
authors.affiliation: Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Sciences, Otsu, Japan. horie@belle.shiga-med.ac.jp.
authors.forename: Minoru
authors.initials: M
authors.lastname: Horie
authors.affiliation: Lucile Packard Children's Hospital, Division of Pediatric Electrophysiology, Stanford University, Palo Alto, CA, USA. amdubin@stanford.edu.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Dubin
mesh_terms: D001919:Bradycardia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D002648:Child; D019468:Disease Management; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male
keywords: Atrioventricular block; Bradycardia; Pacemaker; Sinus node dysfunction; Sudden death