Treatment for bradycardia depends on its underlying cause, whether it is causing symptoms, and whether it is likely to get worse. After your doctor knows the exact cause of your slow heart rate, he or she will determine which treatment you need.

Typically, bradycardia needs to be treated if it is causing symptoms such as fainting or severe, disabling fatigue.

Initial treatment

In an emergency situation when the heart rate slows suddenly, such as after a heart attack, you may need medicines given intravenously for a short time to increase your heart rate.

If another heart condition has damaged your heart's electrical system, your doctor will check to see whether a pacemaker is right for you. You may receive a temporary pacemaker until a permanent pacemaker can be placed.

If an underlying disease, such as hypothyroidism or abnormal potassium levels, is causing your slow heart rate, your doctor will treat that condition. If your bradycardia is caused by heart medicines, such as beta-blockers, calcium channel blockers, antiarrhythmics, or digoxin, your doctor will try to adjust your medicines.

Ongoing treatment

Bradycardia is often caused by an underlying heart condition that has damaged the heart's electrical system. People older than 65 are most likely to develop one of several different types of bradycardia that usually require a permanent pacemaker.

If heart medicines such as beta-blockers, calcium channel blockers, antiarrhythmics, or digoxin are causing bradycardia, your doctor most likely will try first to adjust or change medicines. But many times the medicines cannot be stopped or adjusted, because they are needed to treat other heart conditions. In these cases, you may have a permanent pacemaker implanted so that you can continue to take critical medicines.

Treatment if the condition gets worse

Typically, pacemakers improve symptoms and may prolong life in people with bradycardia. But further treatment depends on the underlying cause of bradycardia. Many people have other underlying heart conditions, such as coronary artery disease, that require additional treatment.

If you have episodes of a slow heart rate alternating with a rapid, irregular heart rate (atrial fibrillation), you may have a higher risk for a stroke. With atrial fibrillation, erratic electrical impulses cause the upper chambers of the heart (atria) to quiver, or fibrillate. Because the atria do not pump effectively, blood pools there and can clot, significantly increasing the risk of stroke and death from stroke. A stroke can happen when the clot travels from the heart and blocks blood flow to the brain.

If you are at risk of a stroke, a pacemaker is usually used along with anticoagulant medicines, which reduce the risk of clotting and stroke. You may need other medicines to prevent a fast heart rate or to slow your heart rate during these episodes. The pacemaker does not treat the fast heart rhythm. But it may allow you to safely take medicines that can treat the fast rhythm.