Journal Article

Cardioinhibitory carotid sinus hypersensitivity predicts an asystolic mechanism of spontaneous neurally mediated syncope

Roberto Maggi, Carlo Menozzi, Michele Brignole, Cristian Podoleanu, Matteo Iori, Richard Sutton, Angel Moya, Franco Giada, Serafino Orazi and Nicoletta Grovale

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 9, issue 8, pages 563-567
Published in print August 2007 | ISSN: 1099-5129
Published online May 2007 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/eum092
Cardioinhibitory carotid sinus hypersensitivity predicts an asystolic mechanism of spontaneous neurally mediated syncope

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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.

Keywords: Syncope; Diagnosis; Electrocardiographic monitoring; Implantable loop recorder; Carotid sinus massage; Carotid sinus hypersensitivity

Journal Article.  2968 words.  Illustrated.

Subjects: Cardiovascular Medicine

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