When should I consider referring a patient with bradycardia for further cardiological evaluation?

You should consider referring a patient with bradycardia for further cardiological evaluation in several circumstances, particularly if there are associated symptoms or specific ECG findings.

• Urgent Referral (within 24 hours):
• Refer urgently if the patient has a history of syncope or near syncope alongside bradycardia ¹.
• If the patient has experienced Transient Loss of Consciousness (TLoC) and their 12-lead electrocardiogram (ECG) shows an abnormality such as a conduction abnormality (e.g., any degree of heart block) or inappropriate persistent bradycardia ². This referral should be reviewed and prioritised by a specialist within 24 hours ².
• Urgent referral is also indicated if TLoC occurs during exertion ².
• Consider urgent referral if there is a family history of sudden cardiac death in people aged younger than 40 years and/or an inherited cardiac condition ¹,².
• For patients aged over 65 years who have experienced TLoC without prodromal symptoms, consider referring within 24 hours for cardiovascular assessment ².
• Routine Referral:
• Refer routinely to cardiology if the 12-lead ECG shows second-degree or third-degree atrioventricular block ¹.
• Consider routine referral if the patient has accompanying chest pain or lightheadedness ¹.
• Refer if there is a history or physical symptoms of structural heart disease, heart failure, or hypertension ¹.
• If a resting ECG abnormality, other than second-degree or third-degree atrioventricular block, is present ¹.