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Cited by 95Cardiovascular Syncope and Autonomic DisordersCardiac pacing and defibrillation studiesHeart Rate Variability and Autonomic Control

Carotid sinus hypersensitivity: beneficial effects of dual-chamber pacing

Madigan, Niall P., Flaker, Greg C., Curtis, Jack J., Reid, John, Mueller, Karl J., Murphy, Thomas J.·1984·The American Journal of Cardiology
DOI 10.1016/0002-9149(84)90632-5
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Abstract

Three types of carotid sinus (CS) syndrome have been described: cardioinhibitory, vasodepressor and mixed. For the treatment of symptomatic patients with associated significant cardioinhibition, permanent ventricular demand pacing systems are often implanted. Even with this pacing modality, some patients remain symptomatic because of continued (and at times aggravated) vasodepression. This study assesses the effects of loss of atrial preloading and orthostasis after carotid massage in patients with CS hypersensitivity. Eleven patients were studied using constant intra-arterial pressure measurements during either ventricular (VVI) or atrioventricular sequential (DVI) pacing in both supine or upright positions. The measurements performed included the magnitude of decrease in arterial blood pressure (BP), the rate of decrease of BP and the percent change in BP from baseline values. After carotid massage, all 11 patients had greater hemodynamic change with the VVI than DVI pacing mode, whether in the supine or upright position. The decreases in systolic BP were: DVI (supine) 29 mm Hg, VVI (supine) 48 mm Hg, DVI (upright) 37 mm Hg, and VVI (upright) 59 mm Hg (mean group values, p less than 0.001). The rates of decrease of systolic BP were: DVI (supine) 2.9 mm Hg/s, VVI (supine) 5.7 mm Hg/s, DVI (upright) 4.1 mm Hg/s, and VVI (upright) 8.3 mm Hg/s (mean group values, p less than 0.001). VVI pacing, particularly in the upright position, resulted in a significant increase in the incidence of patient symptoms (p = 0.03). Thus, in CS hypersensitivity, VVI pacing results in significant hemodynamic deterioration compared to DVI mode. This aggravation of the vasodepressor component results in increased patient symptoms, and therefore, DVI is the optimal pacing mode.

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Crossref · 10.1016/0002-9149(84)90632-5

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  • In CSS, dual-chamber pacing is better than single-chamber ventricular mode in counteracting BP fall during CSM and in preventing symptom recurrences.

    “In CSS, a few small controlled studies 304,305 and one registry 306 showed that dual-chamber pacing is better than the single chamber ventricular mode in counteracting BP fall during CSM and in preventing symptom recurrences.”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [304]

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Authors
Madigan, N. P., Flaker, G. C., Curtis, J. J., Reid, J., Mueller, K. J., & Murphy, T. J.
Affiliations
University of Missouri (US)
Corresponding author
Madigan, Niall P.
ORCID
Murphy, Thomas J.
Venue
The American Journal of Cardiology
Publisher
Elsevier BV
Published
1984-04
Volume
53
Issue
8
Pages
1034-1040
ISSN
0002-9149 (ISSN-L)
DOI
10.1016/0002-9149(84)90632-5
OpenAlex
W2005825052
Cited by
95
References
33
Citations by year
2026: 1 · 2023: 1 · 2021: 1 · 2018: 4 · 2017: 7 · 2016: 1 · 2014: 5 · 2013: 3 · 2012: 1
FWCI
8.00
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The American Journal of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
carotid sinus hypersensitivity, carotid sinus syndrome, DDD pacing, ventricular demand pacing, VVI pacing, vasodepression, cardioinhibition, orthostatic blood pressure, hemodynamic response
MeSH terms
Adult, Aged, Blood Pressure, Cardiac Pacing, Artificial, Carotid Sinus, Female, Heart Conduction System, Hemodynamics, Humans, Male, Massage, Middle Aged, Posture, Venous Pressure

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