Screening
Screening for bradycardia is not carried out normally because treatment is usually administered for symptomatic patients only.
Patients may present with conditions that potentially predispose to bradycardia during routine office visits, and these can be identified easily based on a review of the patient's medical history (e.g., hypothyroidism, medications, and history of myocardial infarction). Treatment is not offered unless the vital signs (hypotension and bradycardia) suggest that the patient is or may be at risk of lightheadedness, syncope, or other complications.
Screening ECGs and Holter monitoring may be considered for special patient populations, such as those with muscular dystrophies (e.g., myotonic dystrophy type 1, Kearns-Sayre syndrome, peroneal muscular dystrophy, or limb-girdle muscular dystrophy), which affect the conduction system of the heart specifically. Patients with neuromuscular diseases associated with conduction disorders, including myotonic dystrophy type 1 or Kearns-Sayre syndrome, who have evidence of second-degree atrioventricular (AV) block, third-degree AV block, or an abnormal electrophysiology study (H-V interval of ≥70 ms) should be referred for pacemaker (or implantable cardioverter defibrillator [ICD] if there is concomitant systolic dysfunction) implantation regardless of symptoms if meaningful survival of more than 1 year is expected.[11]
Genetic screening for patients with bradycardia is not routinely recommended. Genetic mutations affecting AV conduction (e.g., SCN5A) or sinus node function (e.g., HCN4) account for a small proportion of patients who present with bradycardia. Genetic counseling followed by targeted genetic testing, and close clinical monitoring for development of sinus node dysfunction or AV conduction abnormalities, may be considered for asymptomatic first-degree relatives of an individual with a genetic mutation known to be associated with bradycardia (index case).[11][41]
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