What is the preferred initial treatment for a patient with symptomatic bradycardia?

The preferred initial treatment for a patient with symptomatic bradycardia is transcutaneous pacing. This method is indicated when the patient is exhibiting symptoms due to a slow heart rate, such as dizziness, weakness, or hypotension. Transcutaneous pacing involves using external electrodes placed on the skin to deliver electrical impulses to the heart, prompting it to beat at a faster rate. This is crucial for restoring adequate cardiac output and alleviating the symptoms caused by bradycardia.

Transcutaneous pacing is typically rapid to implement in emergency settings and does not require invasive procedures, making it an ideal first-line treatment in acute scenarios. By increasing the heart rate, this intervention can stabilize the patient while further evaluations and treatments are planned.

Other treatments like defibrillation and cardioversion are used for different types of arrhythmias, particularly those that result in an unstable tachycardia or shockable rhythms, which is not the case with bradycardia. Intravenous fluid administration may be supportive in some cases, particularly if the patient is hypotensive or dehydrated, but it does not address the underlying problem of bradycardia itself. Therefore, transcutaneous pacing directly targets the critical issue, making it the first-line treatment.