This protocol covers the management of bradyarrhythmias occurring in the context of digoxin toxicity when the initial treatment step has not achieved resolution of the rhythm disturbance.
The initial approach to bradyarrhythmias in this setting involves atropine. Agents such as adrenaline and isoprenaline are avoided at that stage because of the risk of ventricular fibrillation. When the target — resolution of bradyarrhythmias — is not reached, escalation to the next protocol step is indicated.
When atropine has not resolved the bradyarrhythmia, cardiac pacing may be considered — though it requires specific clinical conditions and expert oversight that are defined in the full protocol.
The clinical goal remains resolution of bradyarrhythmias.
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.
Cardiac pacing requires extreme caution and, while necessary and beneficial for some patients, should only be undertaken if digoxin immune Fab is not immediately available and by clinicians with the requisite expertise and within a coronary care or cardiac intensive care setting.
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