Clinical Outcomes of Various Management Strategies for Symptomatic Bradycardia.
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.
Abrich, Victor A; Le, Rachel J; Mulpuru, Siva K; Friedman, Paul A; Barsness, Gregory W; Cha, Yong-Mei; Lennon, Ryan J; Lewis, Bradley R; and Yang, Eric H, "Clinical Outcomes of Various Management Strategies for Symptomatic Bradycardia." (2020). Articles, Abstracts, and Reports. 2798.