Background: Heart rate is usually used in pediatric early warning scores; primary bradycardia may cause high morbidity and rarely sudden cardiac death.

Objective: Good assessment of primary bradycardia in children and Proper management of critically ill child to prevent sudden death.

Patients and methods: The study was prepared in Pediatric Arrhythmia Clinic, Emergency room department and outpatient clinic from March 2020 to August 2021. Children aged from 1day to 14 years presenting with 1ry bradycardia were enrolled in our study. Pre-death bradycardia was excluded. Full medical history, physical examination, basic investigations, 12 leads ECG and echocardiography were done to all included patients in this study. Thyroid profile and Holter monitoring were done while indicated.

Results: 61 patients were included in the study. Heart rate ranged from 46 to 90 beat/minute with mean 67.44 bpm. Out of 61 patients were included in the study 30 patients (49.2) were primary bradycardia. 50 % of them had Syncopal attacks and another 50 % was diagnosed during routine examination. ASD detected in 20% of them, 20% had CHB; the remaining 60% were Idiopathic. Sinus bradycardia was present in 18 children, CHB was present in 6 patients while 1st and 2nd degree AV block were presenting in 6 children.

Conclusion: Primary bradycardia in children needs early, good assessment and well management to decrease the need of acute intervention and preventing sudden death.