Initial Evaluation of Sinus Bradycardia
Symptomatic sinus bradycardia requires assessment for reversible causes and diagnostic confirmation of the rhythm and rate. [1]
History and Physical Examination
Comprehensive history and physical examination are recommended to evaluate suspected bradycardia and conduction disorder. [1]
History should focus on symptom–rhythm correlation and potential reversible contributors. [1]
Electrocardiographic Confirmation
In patients with suspected bradycardia or conduction disorder, a 12-lead ECG is recommended to document rhythm and rate and to assess conduction abnormalities and signs of structural heart or systemic disease. [1]
Reversible Cause Assessment
In symptomatic patients presenting with sinus node dysfunction, evaluation and treatment of reversible causes are recommended. [1]
Reversible or treatable contributors commonly include metabolic abnormalities, electrolyte abnormalities, hypothyroidism, medications, infection, and hypoxemia-related disorders such as sleep apnea. [1]
Directed Laboratory Testing
Directed blood testing is reasonable when clinical features suggest a specific reversible etiology. [1]
Thyroid function testing is an example of directed laboratory testing when hypothyroidism is suspected. [1]
Ambulatory ECG Monitoring for Symptom–Rhythm Correlation
When symptoms are not captured on the initial ECG, ambulatory ECG monitoring is recommended to establish a diagnosis that correlates symptoms with bradyarrhythmia. [1]
Monitor selection should be based on symptom frequency. [1]
Exercise Testing for Exercise-Related Symptoms
Exercise ECG testing is reasonable when symptoms are exercise related and sinus node dysfunction is suspected. [1]
Echocardiography for Suspected Structural Heart Disease
Transthoracic echocardiography is reasonable when structural heart disease is suspected. [1]
Infrequent Symptoms and Prolonged Monitoring Options
When symptoms are infrequent and ongoing concern remains despite non-diagnostic evaluation, prolonged monitoring options such as implantable cardiac monitoring may be considered. [1]
Advanced Testing and EP Study
Electrophysiology study is not performed primarily to diagnose sinus node dysfunction. [1]
Electrophysiology study may be considered when already being performed for other clinical reasons. [1]