Bradycardia Risk in Lumbar Surgery

The American College of Cardiology, American Heart Association, and Heart Rhythm Society identify age >60-65 years as a significant risk factor for bradycardia during noncardiac surgery, including lumbar procedures 1, 3
Baseline heart rate <60 bpm is a risk factor for bradycardia during noncardiac surgery, including lumbar procedures 1, 3
The American College of Cardiology, American Heart Association, and Heart Rhythm Society identify ASA Class III or IV comorbidities as a risk factor for bradycardia during noncardiac surgery, including lumbar procedures 1
Baseline blood pressure <110/60 mmHg is a risk factor for bradycardia during noncardiac surgery, including lumbar procedures 1
Concurrent use of beta-blockers or renin-angiotensin system blockers is a risk factor for bradycardia during noncardiac surgery, including lumbar procedures 1, 3

Mechanism of Bradycardia in Lumbar Surgery

In noncardiac surgery settings, intraoperative bradycardia is most commonly attributable to sinus node dysfunction (SND) and only rarely due to worsening atrioventricular conduction 1, 2

For high-risk patients, the American College of Cardiology, American Heart Association, and Heart Rhythm Society recommend placement of transcutaneous pacing pads before surgery begins, with a Class IIa recommendation 1, 4
The American College of Cardiology, American Heart Association, and Heart Rhythm Society recommend reviewing and considering holding negative chronotropic medications for high-risk patients 3
Ensuring atropine is immediately available is recommended for high-risk patients 3
Planning for continuous heart rate monitoring is recommended for high-risk patients 3

If bradycardia develops during lumbar surgery, stopping any provocative maneuvers temporarily and allowing patient recovery is recommended 3
Ensuring adequate oxygenation and ventilation is recommended if bradycardia develops during lumbar surgery 3
Administering atropine 0.5-1 mg IV for persistent bradycardia, repeatable every 3-5 minutes up to 3 mg maximum, is recommended 3

Routine prophylactic temporary transvenous pacing should not be performed, even in patients with left bundle branch block requiring pulmonary artery catheterization, as the incidence of complete heart block is low and prophylactic pacing carries increased risk of ventricular arrhythmias (Class III: Harm) 1, 2, 4

The American College of Cardiology, American Heart Association, and Heart Rhythm Society advise against assuming lumbar surgery itself causes bradycardia, as the risk stems from patient factors and anesthetic management, not the surgical site 1
The American College of Cardiology, American Heart Association, and Heart Rhythm Society advise against routinely placing transvenous pacing wires, as transcutaneous pads are sufficient for high-risk patients 1, 4