Bradyarrhythmias in Digoxin Toxicity: What Is the Treatment?
When digoxin toxicity produces bradyarrhythmias, the management approach must be carefully selected. Not all rhythm-modifying agents are safe in this setting — some carry a specific risk of precipitating dangerous ventricular arrhythmias.
This protocol applies to patients with bradyarrhythmias arising in the context of digoxin toxicity — a high-risk presentation requiring targeted pharmacological decision-making. The presence of glycoside toxicity restricts the agents that can safely be used to treat the slow heart rate.
A specific pharmacological agent is available as first-line treatment for the bradyarrhythmia; however, certain sympathomimetic agents are contraindicated in this setting due to the risk of triggering ventricular fibrillation.
The complete agent selection, contraindication rationale, and escalation pathway are in the full structured protocol.
Clinical goal: Resolution of bradyarrhythmiasReferences
DOI: 10.1097/MEJ.0000000000001065
Bradyarrhythmias can be treated with atropine, but drugs such as adrenaline and isoprenaline should be avoided as they can trigger ventricular fibrillation; cardiac pacing may be needed for some patients, but should only be undertaken by expert teams.
View source ↗