Management of Bradycardia

Atropine Administration

• The American College of Cardiology recommends an initial dose of atropine of 0.5-1 mg IV for symptomatic bradycardia, repeated every 3-5 minutes as needed to a maximum total dose of 3 mg 1, 2, 3
• Atropine has a peak action within 3 minutes of IV administration 4
• The American College of Cardiology suggests monitoring blood pressure and heart rate response, as well as observing for signs of increased ischemia in patients with coronary artery disease during atropine administration 4

Contraindications and Side Effects

• Atropine is contraindicated in asymptomatic bradycardia (heart rate >40 bpm) and Type II second-degree AV block 4
• Atropine may cause side effects such as tachycardia, dry mouth, blurred vision, ventricular arrhythmias, and central nervous system effects with repeated doses 4
• Rarely, ventricular tachycardia and fibrillation may occur 4

Special Considerations

• The American College of Cardiology recommends caution when administering atropine to patients with third-degree AV block with new wide QRS complex, heart transplant patients without evidence of autonomic reinnervation, and patients with coronary artery disease 4, 2, 3
• Atropine is indicated for:
• Doses less than 0.5 mg may cause paradoxical bradycardia, and careful observation is necessary after administration to monitor for increased ischemia in susceptible patients 4