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ACLS Bradycardia Algorithm (AHA 2025)

ACLS Bradycardia Algorithm (AHA 2025): Bradyarrhythmia Identified → Signs of Hemodynamic Instability → Persistent Symptomatic Bradycardia? → ATROPINE → ...

Interactive Decision Tree

Mini Map

Algorithm Steps

  1. Start

    Bradyarrhythmia Identified

    HR typically <50/min with symptoms

    • 2025 Update: <50/min threshold
    • Assess appropriateness for clinical condition
    1. Warning

      Signs of Hemodynamic Instability

      Any present?

      • Hypotension
      • Acutely altered mental status
      • Signs of shock
      • Ischemic chest discomfort
      • Acute heart failure
      1. Decision

        Persistent Symptomatic Bradycardia?

        If Yes:

        1. Action

          ATROPINE

          First-line treatment

          • First dose: 1 mg IV/IO
          • Repeat every 3-5 minutes
          • Maximum total: 3 mg
          1. Warning

            Atropine Unlikely Effective In:

            Consider pacing early

            • Mobitz Type II 2° AV block
            • 3° (complete) AV block
            • Wide QRS 3° block
            • Heart transplant patients
          2. Decision

            Atropine Effective?

            If Yes:

            1. Outcome

              Stabilized

              Continue monitoring, address etiology

            If No:

            1. Action

              Epinephrine Infusion

              Alternative/adjunct

              • 2-10 mcg/min IV
              • Titrate to response

        If No:

        1. Outcome

          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

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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