CHALLENGES IN DIAGNOSING SYMPTOMATIC BRADYCARDIAS

Abstract

Symptomatic bradycardias, defined by a heart rate below 60 beats per minute associated with manifestations such as syncope or hemodynamic instability, represent a significant diagnostic challenge due to the wide spectrum of etiologies, ranging from physiological adaptations in athletes to structural disorders and, primarily, extrinsic causes, such as those induced by drugs. This study, a narrative literature review, aimed to synthesize recent scientific evidence related to the challenges in diagnosing these arrhythmias. The results highlight the growing role of pharmacological agents—including emerging therapies such as Paxlovid and oncological agents such as Rituximab and Pazopanib—in the genesis of severe bradycardias and syncope, requiring rigorous monitoring and a thorough pharmacological history. Furthermore, digoxin toxicity in elderly patients and the distinction between physiological and pathological bradycardia in veteran athletes remain notable challenges. It is concluded that the early identification of reversible etiologies, frequently linked to medications, is crucial to avoid unnecessary invasive interventions, such as the implantation of cardiac devices, demanding a systematic and multidimensional diagnostic approach that integrates clinical, electrocardiographic, and pharmacological aspects.