Therapy

Give symptomatic patients (e.g. evidence of heart failure, chest pain or reduced consciousness) ^d atropine ^c

• remain symptomatic ^a
• with episodes of ventricular standstill ^a
• an anterior myocardial infarction with Mobitz II or 3^rd degree heart block ^d

Use either: 

• transcutaneous pacing
• transvenous pacing, ^a preferably using balloon-flotation catheters  

Consider giving potassium, glucose and insulin in 2nd or 3rd degree heart block if pacing is not available. ^c

Insert a permanent pacemaker in patients with

• sick sinus syndrome  ^a
• carotid sinus syndrome ^c  
• ventricular standstill ^a
• Mobitz II or 3^rd degree heart block ^d
  
  
• Provide antibiotic prophylaxis during pacemaker insertion ^a  

Carotid sinus syndrome

• Use dual-chamber pacing ^a

Sick sinus syndrome

• Use atrial pacing ^a 
• Consider starting slow-release theophylline ^a