UMEM Educational Pearls

Category: Cardiology

Title: 2010 AHA Guidelines: bradycardias

Keywords: bradycardia, bradydysrhythmia, atropine, transplant (PubMed Search)

Posted: 11/21/2010 by Amal Mattu, MD
Click here to contact Amal Mattu, MD

We mentioned atropine's elimination from the cardiac arrest (asystole, PEA) protocols last week. Atropine (0.5 mg) is still indicated in unstable bradycardias that appear to be vagally-mediated, such as sinus bradycardia and Mobitz I bradycardia.

Beware, however, that atropine is not recommended in patients with transplanted hearts. These hearts lack vagal innervation, and in fact there's one small study suggesting that atropine may be associated with paradoxical slowing of the heart rate and worsening AV block. Go straight to pacing with these patients.



Neumar RW, Otto CW, Link MS, et al. Part 8: Adult Advanced Cardiovascular Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122:S729-S767.