Clinical Outcomes of Various Management Strategies for Symptomatic Bradycardia.

Document Type


Publication Date


Publication Title

Clin Med Res


OBJECTIVE: To determine clinical outcomes of various management strategies for reversible and irreversible causes of symptomatic bradycardia in the inpatient setting.

DESIGN: Retrospective observational study.

SETTING: Emergency Room and Inpatient.

PARTICIPANTS: Patients presenting to the Emergency Department with symptomatic bradycardia.

METHODS: We retrospectively reviewed electronic health records of 518 patients from 2 Mayo Clinic campuses (Rochester and Phoenix) who presented to the emergency department with symptomatic bradycardia (heart rate ≤50 beats/minute) from January 1, 2010 through December 31, 2015. Sinus bradycardia was excluded. The following management strategies were compared: observation, non-invasive management (medications with/without transcutaneous pacing), early permanent pacemaker (PPM) implantation (≤2 days), and delayed PPM implantation (≥3 days). Study end points included length of stay and adverse events related to bradycardia (syncope, central line-associated bloodstream infections, cardiac arrest, and in-hospital mortality). Patients who received a PPM were further stratified by weekend hospital admission.

RESULTS: Heart block occurred in 200 (38.6%) patients, and atrial arrhythmias with slow ventricular response occurred in 239 (46.1%) patients. Reversible causes of bradycardia included medication toxicity in 22 (4.2%) patients and hyperkalemia in 44 (8.5%) patients. Adverse events were similar in patients who underwent early compared to delayed PPM implantation (6.6% vs 12.5%,

CONCLUSIONS: Delayed PPM implantation was not associated with an increase in adverse events. Weekend PPM implantation should be considered to reduce temporary transvenous pacing and shorten length of stay.

Clinical Institute

Cardiovascular (Heart)




Emergency Medicine