{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T07:24:42Z","timestamp":1785741882341,"version":"3.56.0"},"reference-count":12,"publisher":"Class Publishing","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["British Paramedic Journal"],"published-print":{"date-parts":[[2022,9,1]]},"abstract":"<jats:p><jats:bold>Introduction:<\/jats:bold> Bradyarrhythmias are a common entity in both emergency and out-of-hospital (OOH) medicine. In unstable bradycardic patients, paramedics will often initiate life-saving therapies in the OOH setting. Clinical guidelines for bradyarrhythmias are largely consistent\n across the globe, with intravenous (IV) atropine recommended as a first-line therapy, escalating to IV adrenaline or isoprenaline and transcutaneous pacing where atropine is unsuccessful. In this case report, we describe a case in the OOH setting of ventricular standstill following the administration\n of atropine to a patient with bradycardia and 2:1 heart block.<jats:bold>Case presentation:<\/jats:bold> The patient was a 77-year-old female presenting with a symptomatic 2:1 heart block. Following a single dose of 600 micrograms IV atropine, the patient deteriorated into ventricular standstill with a\n loss of consciousness and decorticate posturing. The patient was successfully managed with an IV infusion of adrenaline and subsequently received an implanted pacemaker in hospital.<jats:bold>Conclusion:<\/jats:bold> The paradoxical worsening of this patient\u2019s bradycardia following atropine administration\n may have been related to the location of the heart block. It has been shown that patients with atrioventricular blocks at the level of the His-Purkinje fibres (infranodal) are at an increased risk of adverse events following atropine administration, while those at the nodal level or secondary\n to increased vagal tone are more likely to respond favourably. Paramedics should be prepared to manage unexpected adverse events secondary to atropine administration in patients with heart block.<\/jats:p>","DOI":"10.29045\/14784726.2022.09.7.2.38","type":"journal-article","created":{"date-parts":[[2022,8,30]],"date-time":"2022-08-30T00:40:34Z","timestamp":1661820034000},"page":"38-42","source":"Crossref","is-referenced-by-count":5,"title":["Paradoxical worsening of bradycardia following atropine administration"],"prefix":"10.29045","volume":"7","author":[{"given":"Richard","family":"Armour","sequence":"first","affiliation":[{"name":"Ambulance Victoria"},{"name":"Monash University"},{"name":"Charles Sturt University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charmane","family":"Learning","sequence":"additional","affiliation":[{"name":"British Columbia Emergency Health Services"},{"name":"Columbia Paramedic Academy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"11578","reference":[{"issue":"2\u20133","key":"bibr_1","doi-asserted-by":"crossref","first-page":"75","DOI":"10.3121\/cmr.2019.1507","article-title":"Clinical outcomes of various management strategies for symptomatic bradycardia","volume":"18","author":"Abrich","year":"2020","journal-title":"Clinical Medicine & Research"},{"issue":"3","key":"bibr_2","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1053\/ajem.2001.21715","article-title":"2:1 atrioventricular block: Order from chaos","volume":"19","author":"Barold","year":"2001","journal-title":"American Journal of Emergency Medicine"},{"issue":"8","key":"bibr_3","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1097\/01.TP.0000122416.70287.D9","article-title":"Atropine often results in complete atrioventricular block or sinus arrest after cardiac transplantation: An unpredictable and dose-independent phenomenon","volume":"77","author":"Bernheim","year":"2004","journal-title":"Transplantation"},{"issue":"Suppl 1","key":"bibr_4","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/2048872615604119","article-title":"Pre-hospital management of patients with chest pain and\/or dyspnoea of cardiac origin","volume":"9","author":"Beygui","year":"2020","journal-title":"European Heart Journal. Acute Cardiovascular Care"},{"key":"bibr_5","first-page":"44","article-title":"Atrioventricular block","volume":"1","author":"Bhargava","year":"2012","journal-title":"Journal of Clinical and Preventative Cardiology"},{"issue":"9","key":"bibr_6","first-page":"1","article-title":"Evaluation and management of bradydysrhythmias in the emergency department","volume":"15","author":"Deal","year":"2013","journal-title":"Emergency Medicine Practice"},{"issue":"11","key":"bibr_7","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1016\/j.cardfail.2013.10.002","article-title":"The risk of adverse events associated with atropine administration during dobutamine stress echocardiography in cardiac transplant patients: A 28-year single-center experience","volume":"19","author":"Ji","year":"2013","journal-title":"Journal of Cardiac Failure"},{"issue":"2","key":"bibr_8","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.ihj.2013.02.003","article-title":"Nodal and infranodal atrioventricular conduction block: Electrophysiological basis to correlate the ECG findings","volume":"65","author":"Kantharia","year":"2013","journal-title":"Indian Heart Journal"},{"issue":"7","key":"bibr_9","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1016\/j.jacc.2018.10.043","article-title":"2018 ACC\/AHA\/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: A report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines and the heart rhythm society","volume":"74","author":"Kusumoto","year":"2019","journal-title":"Journal of the American College of Cardiology"},{"key":"bibr_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.resuscitation.2021.02.003","article-title":"European Resuscitation Council Guidelines 2021: Executive summary","volume":"161","author":"Perkins","year":"2021","journal-title":"Resuscitation"},{"issue":"6","key":"bibr_11","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1111\/j.1553-2712.2004.tb00719.x","article-title":"Clinical variables associated with mortality in out-of-hospital patients with hemodynamically significant bradycardia","volume":"11","author":"Schwartz","year":"2004","journal-title":"Academic Emergency Medicine"},{"key":"bibr_12","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.resuscitation.2015.07.016","article-title":"European Resuscitation Council guidelines for resuscitation 2015: Section 3. Adult advanced life support","volume":"95","author":"Soar","year":"2015","journal-title":"Resuscitation"}],"container-title":["British Paramedic Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ingentaconnect.com\/content\/tcop\/bpj\/2022\/00000007\/00000002\/art00006","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T16:04:43Z","timestamp":1758729883000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ingentaconnect.com\/content\/10.29045\/14784726.2022.09.7.2.38"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,1]]},"references-count":12,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022,9,1]]}},"alternative-id":["1478-4726(20220901)7:2L.38;1-"],"URL":"https:\/\/doi.org\/10.29045\/14784726.2022.09.7.2.38","relation":{},"ISSN":["1478-4726"],"issn-type":[{"value":"1478-4726","type":"print"}],"subject":[],"published":{"date-parts":[[2022,9,1]]}}}