Bradyarrhythmia Identified
HR typically <50/min with symptoms
- 2025 Update: <50/min threshold
- Assess appropriateness for clinical condition
All Pathways
CardiologyEmergency
ACLS Bradycardia Algorithm (AHA 2025)
ACLS Bradycardia Algorithm (AHA 2025): Bradyarrhythmia Identified → Signs of Hemodynamic Instability → Persistent Symptomatic Bradycardia? → ATROPINE → ...
Pathway Overview
12 steps
Algorithm Steps
12 total
01Start 02Warning Signs of Hemodynamic Instability
Any present?
- Hypotension
- Acutely altered mental status
- Signs of shock
- Ischemic chest discomfort
- Acute heart failure
03Decision Persistent Symptomatic Bradycardia?
- If Yes
04Action ATROPINE
First-line treatment
- First dose: 1 mg IV/IO
- Repeat every 3-5 minutes
- Maximum total: 3 mg
05Warning Atropine Unlikely Effective In:
Consider pacing early
- Mobitz Type II 2° AV block
- 3° (complete) AV block
- Wide QRS 3° block
- Heart transplant patients
06Decision Atropine Effective?
- If Yes
07Outcome Stabilized
Continue monitoring, address etiology
If No08Action Transcutaneous Pacing
Class I recommendation
- Consider sedation if conscious
- Verify mechanical capture
- Bridge to transvenous pacing
09Action Consider Transvenous Pacing
If refractory or TCP not effective
- Expert consultation
- Treat underlying causes
- Path rejoins step 07Shared downstream outcome
10Action Dopamine Infusion
Alternative/adjunct
- 5-20 mcg/kg/min IV
- Titrate to response
- Path rejoins step 09Shared downstream outcome
11Action Epinephrine Infusion
Alternative/adjunct
- 2-10 mcg/min IV
- Titrate to response
- Path rejoins step 09Shared downstream outcome
If No12Outcome Monitor & Observe
Identify and treat underlying cause
Guideline Source
2025 AHA Guidelines for CPR and ECC - Adult Advanced Life Support
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Assumes adult patient with pulse
- Drug dosing may vary by institution
- Heart transplant patients: atropine ineffective
Contraindicated Populations
pediatric
Applicable Regions
USEU
EU: ERC guidelines similar with minor variations
US: AHA 2025 - HR threshold <50/min for symptomatic
Version 1Next review: 2030-10-01
Next steps
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Related Resources
Frequently Asked Questions
What is the ACLS Bradycardia Algorithm (AHA 2025)?
The ACLS Bradycardia Algorithm (AHA 2025) is a emergency clinical algorithm for Cardiology. It provides a structured decision tree to guide clinical decision-making, based on 2025 AHA Guidelines for CPR and ECC - Adult Advanced Life Support.
What guideline is the ACLS Bradycardia Algorithm (AHA 2025) based on?
This algorithm is based on 2025 AHA Guidelines for CPR and ECC - Adult Advanced Life Support (DOI: 10.1161/CIR.0000000000001376).
What are the limitations of the ACLS Bradycardia Algorithm (AHA 2025)?
Known limitations include: Assumes adult patient with pulse; Drug dosing may vary by institution; Heart transplant patients: atropine ineffective. Individual patient factors may require deviation from these recommendations.
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