Less syncope and milder symptoms in patients treated with pacing for induced cardioinhibitory carotid sinus syndrome: a randomized study
Open accessAbstract
AIMS: The aim of this study was to examine the effect on symptoms in patients with induced cardioinhibitory carotid sinus syndrome (ICSS) when treated or not treated with a pacemaker. METHODS AND RESULTS: Sixty patients with a history of syncope or pre-syncope and ICSS were randomized to receive a permanent pacemaker (P group, n = 30) or no pacing (NP group, n = 30). ICSS was defined as a ventricular pause (i.e. asystole) lasting 3 s or more in response to carotid sinus stimulation. The patients were seen at 3 and 12 months and at symptoms. At 12 months, the rate of syncope in the NP group was 40% (n = 12) compared with 10% (n = 3) in the P group (P = 0.008). The majority (11 of 12) of the syncope recurrences in the NP group occurred during the first 3 months. Pre-syncope occurred in two patients (7%) in the NP group and in eight (27%) in the P group. Ten patients (33%) with recurrent syncope in the NP group later crossed-over to receive pacemaker implant. CONCLUSIONS: A history of syncope or pre-syncope, plus ICSS, was a strong predictor of subsequent syncope or pre-syncope. Most of the new symptoms occurred within 3 months. Pacemaker treatment effectively reduced syncope and/or resulted in milder symptoms.
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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 [99]
The Definitions section says cardioinhibitory carotid sinus syndrome may be diagnosed even when a close relationship between carotid-sinus manipulation and syncope has not been demonstrated. That contradicts the claim that reproducing spontaneous symptoms during massage is required. The Introduction also notes continuing controversy rather than strong consensus. Page numbers are unavailable in our copy. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredTwo randomized trials confirmed fewer recurrences at follow-up in paced patients than in those without pacing.
“These results were confirmed in two randomized trials. 98,99”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [99]
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- Authors
- Claesson, J.-E., Kristensson, B.-E., Edvardsson, N., & Wahrborg, P.
- Affiliations
- University of Skövde (SE)
- Sahlgrenska University Hospital (SE)
- Corresponding author
- Claesson, J.-E.
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-06-08
- Volume
- 9
- Issue
- 10
- Pages
- 932-936
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2115815539
- Cited by
- 89
- References
- 36
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 5 · 2020: 4 · 2019: 5 · 2018: 4 · 2017: 11 · 2016: 4 · 2015: 3 · 2014: 12 · 2013: 8 · 2012: 2
- FWCI
- 3.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (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
- permanent pacemaker, syncope, presyncope, carotid sinus stimulation, ventricular pause, syncope recurrence, symptom severity
- MeSH terms
- Aged, Cardiac Pacing, Artificial, Cardiovascular Agents, Carotid Sinus, Female, Humans, Male, Middle Aged, Pacemaker, Artificial, Recurrence, Regression Analysis, Syncope, Syndrome, Treatment Outcome, Tilt-Table Test
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