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Cited by 132Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlCardiac electrophysiology and arrhythmias

Neurally mediated syncope detected by carotid sinus massage and head-up tilt test in sick sinus syndrome

Brignole, Michele, Menozzi, Carlo, Gianfranchi, Lorella, Oddone, Daniele, Lolli, Gino, Bertulla, Antonio·1991·The American Journal of Cardiology
DOI 10.1016/0002-9149(91)90491-3
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Abstract

It is generally accepted that a positive response to carotid sinus massage (CSM) or head-up tilt (HUT) in patients affected by syncope suggests a reflex cause of the syncope. To study the role of the autonomic nervous system in causing syncope in the sick sinus syndrome (SSS), CSM and HUT were performed in 35 consecutive patients (20 men, mean age 70 +/- 9 years) with syncope and SSS. Results were compared with those in 35 patients affected by syncope that, despite careful cardiovascular and neurologic examination, were of uncertain origin (21 men; mean age 68 +/- 9 years) and with those of 35 subjects without syncope (20 men; mean age 69 +/- 10). All patients underwent CSM in the supine and standing positions for 10 seconds and HUT to 60 degrees for 60 minutes. In the patients with SSS, the full reproduction of spontaneous symptoms by CSM occurred in 21 (60%) and by HUT, in 19 (54%). At least 1 test was positive in 28 patients (80%): cardioinhibitory or mixed responses in 69%, vasodepressor responses in 11%. The percentages of positive tests in the patients with syncope of uncertain origin were similar to or slightly less than those of patients with SSS (CSM 63%, HUT 26%, overall 74%) with cardioinhibitory or mixed responses in 54% and vasodepressor in 20% (p less than 0.05). In control subjects, syncope was induced by CSM in 1 (3%) and by HUT in 2 (6%); overall positivity was 9%. In conclusion, in most patients affected by syncope and SSS, an abnormal neural reflex probably plays a major role in causing syncope.(ABSTRACT TRUNCATED AT 250 WORDS)

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Crossref · 10.1016/0002-9149(91)90491-3

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  • Multifactorial mechanisms are likely in other types of cardiac syncope, e.g. aortic stenosis, hypertrophic cardiomyopathy (HCM), and sick sinus syndrome.

    “Similarly, multifactorial mechanisms are likely in other types of cardiac syncope, e.g. aortic stenosis, 133 hypertrophic cardiomyopathy (HCM), 134 and sick sinus syndrome. 135,136”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [135]

  • An increased susceptibility to neurally mediated bradycardia/hypotension is often the cause of syncope in patients with sinus node disease.

    “Thus, an increased susceptibility to neurally mediated bradycardia/ hypotension is often the cause of syncope. 135,136”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [135]

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Authors
Brignole, M., Menozzi, C., Gianfranchi, L., Oddone, D., Lolli, G., & Bertulla, A.
Affiliations
Presidio Ospedaliero (IT)
ORCID
Brignole, Michele
Venue
The American Journal of Cardiology
Publisher
Elsevier BV
Published
1991-10
Volume
68
Issue
10
Pages
1032-1036
ISSN
0002-9149 (ISSN-L)
DOI
10.1016/0002-9149(91)90491-3
OpenAlex
W2127225262
Cited by
132
References
22
Citations by year
2025: 1 · 2023: 2 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 3 · 2018: 5 · 2016: 2 · 2014: 2 · 2013: 5 · 2012: 6
FWCI
4.36
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 › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords
syncope, sick sinus syndrome, carotid sinus massage, head-up tilt, neurogenic syncope, autonomic nervous system, cardioinhibitory response, vasodepressor response, neural reflexes
MeSH terms
Aged, Autonomic Nervous System, Carotid Sinus, Female, Humans, Male, Posture, Reflex, Sick Sinus Syndrome, Syncope

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