[Managing bradycardia in adults]

Bradycardia represents a common cause of requirement for specialist advice and it looks sometimes difficult to evaluate its pathological criteria and its medical management. The authors remind the physiological mechanisms and their aetiologies, cardiac or not. Many complementary exams can be employed but a rigorous strategy is necessary, based on the use of electrocardiogram, Holter ECG, implantable loop recorder, stress test, cardiac echography, tilt testing, electrophysiological study. Once the diagnostic established, the next fundamental step consists on a rigorous evaluation of severity in order to recognize the real urgency which require an hospitalization and to initiate rapidly the most appropriate treatment, sometimes before having the complete diagnosis, or to take in charge ambulatory the less severe cases all the more a reversible causes is identified. The situation often needs to take our time to avoid conceding too easily the definitive cardiac pacing. North American guidelines concerning cardiac pacing represent at least the references which we have to follow as often as possible particularly concerning atypical cases.