Bradycardia & Pacing — When Slow Becomes Dangerous

Episode 60: Bradycardia & Pacing — When Slow Becomes Dangerous

Bradycardia isn’t always the problem—until it is.

In this episode, we slow things down and take a clear, practical look at bradycardia and pacing in the field. Not just the algorithm, but the why behind it. We talk through how to recognize when a slow heart rate is actually compromising perfusion, when monitoring turns into intervention, and how to make confident decisions when the patient in front of you doesn’t fit the textbook.

We break down symptomatic vs. asymptomatic bradycardia, common pitfalls in assessment, and why pacing isn’t a failure—it’s a bridge. We also talk honestly about the hesitation providers feel around pacing: fear of causing pain, uncertainty with equipment, and the pressure of making a high-stakes call when time feels compressed.

This conversation goes beyond button-pushing. It’s about clinical judgment, physiology, communication with your patient and your partner, and understanding when atropine isn’t enough—or isn’t appropriate at all.

We also reflect on how bradycardia calls have shaped our confidence as clinicians, the lessons learned from pacing that didn’t go smoothly, and how repetition, preparation, and culture influence whether we act decisively or hesitate.

This episode is about recognizing instability early. Trusting your assessment. Using pacing as a tool—not a last resort. And showing up calmly when the heart rate drops and the room gets quiet.