Bradycardia

Sick Sinus Syndrome (Sinus Bradycardia, Sinus Pauses, Chronotropic Incompetence), Atrioventricular (AV) Block, Neurocardiogenic or Vasovagal Bradycardia (or syncope) 

So you’ve been diagnosed with bradycardia, what does that mean? 

You have a slow heart rate of less than 60 beats per minute.  This is caused by slowed electrical conduction through the heart.  

There are different types of electrical conduction problems that cause bradycardia.  The SA node is the natural pacemaker of the heart.  In a healthy heart, the SA node generates the electrical signal that spreads through the rest of the heart.  When the SA node is not working right, it is called sick sinus syndrome.  The Atrioventricular (AV) Node acts as the electrical bridge between the top and bottom chambers of the heart.  When the AV node is not working right, it is called AV Block.  In more rare situations, people can have problems with bradycardia and fainting that have a healthy cardiac conduction system, but rather, the nervous system signals the heart to go too slow.  This is called neurocardiogenic or vasovagal bradycardia.     

Why Do People Get Bradycardia? 

Is It Dangerous?   

Signs & Symptoms of Bradycardia 

Sometimes people do not feel bradycardia, or they get so used to how they feel when they are bradycardic that they do not recognize the symptoms.
Signs and symptoms of bradycardia include: 

• Fainting (passing out), or feeling very close to fainting 
• Fatigue/tiredness  
• Tiring easily with usual activities or exercise   
• Dizziness  
• Confusion or fogginess  
• Shortness of breath 
• Chest discomfort  

What Should I do if I find that my heartbeat is slow (bradycardia)?

If your heart rate is more than 50 bpm and you have no symptoms, you should just mention it at your next appointment.   

Symptoms of bradycardia you should call your provider about: 

• Lightheadedness, dizziness, or mind fogginess 
• New-onset, mild shortness of breath 
• New-onset, mild chest discomfort   
• New or more severe tiredness even though you have been getting enough sleep  
• Heart rate of less than 50 bpm without symptoms (while awake; not worrisome during sleep) 
• Tiring easily with activity or exercise that does not usually make you stop or catch your breath 

Symptoms of bradycardia to go to the ER for: 

• Lightheadedness, dizziness, or mind fogginess 
• Sudden change in alertness, new or worse confusion, or difficulty waking a person up 
• Fainting or feeling really close to fainting 
• New-onset or worse shortness of breath at rest  
• Severe chest discomfort, especially at rest  

How is bradycardia diagnosed? 

• Ambulatory Rhythm Monitoring (event monitors, holter monitors, loop recorders) 
• ECG (also called EKG): a non-invasive test that records the heart’s electrical impulses for a few seconds 
• Wearable Devices: Personal devices and Smart Devices that you can use at home to capture a simple ECG such as the Apple Watch or Kardia App.   
• Electrophysiology (EP) study 

How is it bradycardia treated? 

Sometimes your provider can fix the problem by adjusting medications that slow the heartbeat.  Otherwise, bradycardia is treated with a pacemaker .  In the case of neurocardiogenic/vasovagal bradycardia, cardioneural ablation can treat the problem.