Cardioinhibitory carotid sinus hypersensitivity predicts an asystolic mechanism of spontaneous neurally mediated syncope
Abstract
AIMS: We correlated the finding of cardioinhibitory carotid sinus hypersensitivity (CSH) with that observed during a spontaneous syncopal relapse by means of an implantable loop recorder (ILR). METHODS AND RESULTS: We included 18 consecutive patients with suspected recurrent neurally mediated syncope and positive cardioinhibitory response during carotid sinus massage (max pause 5.5 +/- 1.6 s) who had subsequent documentation of a spontaneous syncope by means of an ILR. They were compared with a 2:1 age- and sex-matched group of 36 patients with a clinical diagnosis of recurrent neurally mediated syncope and negative response to carotid sinus massage, tilt testing and ATP test. Asystole >3 s was observed at the time of the spontaneous syncope in 16 (89%) of CSH patients and in 18 (50%) of the control group (P = 0.007). Sinus arrest was the most frequent finding among CSH patients but not among controls (72 vs. 28%, P = 0.003). After ILR documentation, 14 CSH patients with asystole received dual-chamber pacemaker implantation; during 35 +/- 22 months of follow-up, 2 syncopal episodes recurred in 2 patients (14%), and pre-syncope occurred in another 2 patients (14%). Syncope burden decreased from 1.68 (95% confidence interval 1.66 - 1.70) episodes per patient per year before to 0.04 (0.038-0.042) after pacemaker implant (98% relative risk reduction). CONCLUSIONS: In patients with suspected neurally mediated syncope, the finding of cardioinhibitory CSH predicts an asystolic mechanism at the time of spontaneous syncope and, consequently, suggests a possible benefit of cardiac pacing therapy.
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The diagnosis of carotid sinus syndrome requires both the reproduction of spontaneous symptoms during carotid sinus massage and clinical features of spontaneous syncope compatible with a reflex mechanism.
“There is strong consensus that the diagnosis of CSS requires both the reproduction of spontaneous symptoms during CSM and clinical features of spontaneous syncope compatible with a reflex mechanism.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [101]
Recordings of long pauses were very common in the two trials that employed implanted device monitoring in patients with a cardioinhibitory response to carotid sinus massage.
“Recordings of long pauses were very common in the two trials that employed this method. 100,101”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [101]
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- Authors
- Maggi, R., Menozzi, C., Brignole, M., Podoleanu, C., Iori, M., Sutton, R., Moya, A., Giada, F., Orazi, S., & Grovale, N.
- Affiliations
- Presidio Ospedaliero (IT)
- Santa Maria Nuova Hospital (IT)
- Royal Brompton & Harefield NHS Foundation Trust (GB)
- Medtronic (Italy) (IT)
- Corresponding author
- Brignole, Michele
- Venue
- EP Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-05-16
- Volume
- 9
- Issue
- 8
- Pages
- 563-567
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2146965324
- Cited by
- 79
- References
- 25
- Citations by year
- 2026: 1 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 2 · 2018: 4 · 2017: 8 · 2016: 1 · 2015: 3 · 2014: 11 · 2013: 7 · 2012: 6
- FWCI
- 7.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- EP Europace (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
- neurally mediated syncope, carotid sinus hypersensitivity, cardioinhibitory response, asystole, sinus arrest, implantable loop recorder, dual-chamber pacemaker, cardiac pacing, carotid sinus massage
- MeSH terms
- Adenosine, Aged, Atrioventricular Node, Electrocardiography, Female, Humans, Male, Sensitivity and Specificity, Sick Sinus Syndrome, Sinoatrial Node, Vasodilator Agents, Reproducibility of Results, Syncope, Vasovagal
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