BRADYCARDIA SYNDROME IN CHILDREN: BETWEEN NORMAL AND PATHOLOGY

The authors address a critical issue in pediatric cardiology—bradycardia in children as a condition encompassing both physiological and pathological variants. The increasing prevalence of cardiac arrhythmias in pediatric populations, particularly among those engaged in competitive sports, necessitates a comprehensive clinical evaluation of this syndrome. The diagnostic challenges are examined through multiple perspectives. The authors provide detailed evaluation of age-specific heart rate norms, emphasizing the critical role of electrocardiographic diagnostics and Holter monitoring in clinical practice. Particular attention is given to the difficulties of symptom interpretation in neonates and young children, where subjective complaints cannot be reliably assessed. Pathophysiological mechanisms are systematically reviewed, covering the spectrum from sinus node dysfunction to various degrees of atrioventricular block. Current research on genetic predisposition is presented, including polymorphisms in genes encoding cardiac ion channels and transcription factors, with special focus on NKX2-5 variants. The discussion extends to the prognostic significance of childhood bradycardia as a potential marker for future cardiac complications. The article further explores clinical associations with infectious diseases, including COVID-19, and examines medication-related effects on pediatric heart rate. Complex clinical scenarios are described where bradycardia represents one component of broader syndromic presentations requiring multidisciplinary management approaches. In conclusion, the authors emphasize the necessity for personalized therapeutic strategies and monitoring protocols. Key components include risk stratification, genetic screening, and application of modern electrophysiological diagnostic methods, all crucial for preventing serious complications such as sudden cardiac death. This work provides clinicians with an evidence-based framework for understanding and managing bradycardia in pediatric practice, integrating current knowledge across diagnostic, pathophysiological and therapeutic domains. The presented concepts support the implementation of evidence-based, preventive and personalized medicine principles in clinical cardiology.