Bradyarrhythmias: what to consider when an unstable bradycardia is not reponding to standard ACLS treatments

ECG Weekly Workout with Dr. Amal Mattu


A 60-year-old woman presents to the ED with dyspnea on exertion and malaise. She is hypotensive and bradycardic. The following ECG is obtained:

Before watching the video, look closely at this ECG and ask yourself these questions:

  1. What is your differential for this markedly bradycardic rhythm?
  2. How would you treat this patient?
  3. What if she does not respond to standard ACLS (atropine and transcutaneous pacing) and decompensates?