Carotid sinus hypersensitivity and syncope

Walter, Paul F.; Crawley, I.Sylvia; Dorney, Edward R.

doi:10.1016/0002-9149(78)90934-7

Cited by 149 publications

(47 citation statements)

References 21 publications

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“…12,286 Macroreentry around the granulomas is the most common mechanism of VA in patients with cardiac sarcoidosis. 280,281 Other mechanisms include triggered activity and abnormal automaticity due to myocardial inflammation.…”

Section: 280-286mentioning

confidence: 99%

“…12 Patients with cardiac sarcoidosis and conduction abnormalities have a worse prognosis than that of patients with idiopathic AV block. 286,287 Immunosuppression can result in transient reversal of AV block; however, the reversibility is unpredictable. [287][288][289] As such, it is recommended to proceed with pacing according to the most recent guidelines regardless of AV block reversibility.…”

Section: 286-289mentioning

confidence: 99%

See 1 more Smart Citation

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

Sheldon²,

et al. 2017

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Section: 280-286mentioning

confidence: 99%

Section: 286-289mentioning

confidence: 99%

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

Sheldon²,

et al. 2017

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“…Mixed cardioinhibitory carotid sinus stimulation has been documented only once before. 13 The later use of a dual chamber (rate responsive) pacemaker with a rate drop algorithm may also have accounted for the patient's subsequent successful management.…”

Section: Discussionmentioning

confidence: 99%

Nasal carcinoma – a rare indication for a permanent pacemaker

et al. 2004

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-Cardiac sinus syncope is a recognised but rare complication of head and neck cancers. Although electrical pacing remains an important treatment to prevent further syncopal episodes related to bradycardia, vasopressorrelated syncope remains a more difficult management problem. The article describes the case of a 66-year-old patient with metastatic squamous cell carcinoma of the nose, who presented with syncope and exhibited carotid sinus syncope related to both carotid body invasion and vasopressor mechanisms. Successful management by the insertion of a permanent pacemaker is described, and a review of the literature on this rare complication is given. KEY WORDS: carotid sinus syncope, pacemaker, squamous cell carcinoma, vasopressor related syncopeMetastatic malignant disease of the head and neck is a recognised but rare cause of carotid sinus syncope. The mechanisms underlying carotid sinus syncope are complex. Recognising the symptoms and signs of the different types of carotid sinus syncope are essential if it is to be managed successfully. Patient historyA 66-year-old man presented in November 1998 with a large 2-cm ulcerating lesion arising from his right nasal vestibule. He had first noticed it one month before and it had rapidly grown since then. The lesion extended from the right nasal vestibule to the floor of the nostril. We found no enlarged lymph glands in the neck. A biopsy of the lesion showed a well differentiated squamous cell carcinoma. A magnetic resonance imaging (MRI) scan of the head and neck was otherwise normal, staging the disease as T3 N0.In view of the difficult location, the patient underwent radiotherapy with a three-field arrangement with a wax block to bolus up the nose and nasal cavity. A dose of 55 Gy in 20 fractions was given over four weeks. After two months, there was no visible tumour at the nostril, and clinical examination at that stage was normal.In May 2001, a right submandibular lymph node was noted. Aspiration of this site revealed metastatic disease, and a 3 cm by 2 cm necrotic lesion was confirmed on repeat MRI scan. The patient underwent a right modified neck dissection; of 17 nodes that were removed only one was positive (20 mm node with extracapsular spread). Adjunct radiotherapy was given to the area: 60 Gy to the right neck and 50 Gy to the left neck. He made a good postoperative recovery.The patient presented in December 2001 to casualty after a syncopal episode. There were no preceding symptoms. Localised cutaneous radiotherapy changes affecting the right neck, a right palatal palsy and right vocal cord palsy suggested a right vagal nerve palsy. There was no palpable lymphadenopathy. Routine X-ray and laboratory investigations were also normal. While being monitored in hospital, he had another witnessed syncopal episode associated with profound sinus bradycardia (pulse 38 b/min, blood pressure 60/40) (see Fig 1a). This rapidly responded to a bolus of 1 mg intravenous atropine. A temporary pacing wire was inserted (Fig 1b). Over the next five days, the p...

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“…Reproducibility has been questioned by others. 30 Previous studies have used a suction method, which, while not used clinically, may be more consistent. 31 …”

Section: Limitationsmentioning

confidence: 99%

Assessment of the Vasodepressor Reflex in Carotid Sinus Syndrome

Solari

Maggi

Oddone

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-Assessment of the vasodepressor reflex in carotid sinus syndrome is influenced by the method of execution of the carotid sinus massage and the coexistence of the cardioinhibitory reflex. Methods and Results-Carotid sinus massage reproduced spontaneous symptoms in 164 patients in the presence of hypotension or bradycardia (method of symptoms). When an asystolic pause was induced, the vasodepressor reflex was reassessed after suppression of the asystolic reflex by means of 0.02 mg/kg IV atropine. An isolated vasodepressor form was found in 32 (20%) patients, who had lowest systolic blood pressure (SBP) of 65±15 mm Hg. Of these, only 21 (66%) patients had an SBP fall ≥50 mm Hg, which is the universally accepted cut-off value for the diagnosis of the vasodepressor form. Conversely, a lowest SBP value of ≤85 mm Hg (corresponding to the fifth percentile) detected 97% of vasodepressor patients, but was also present in 84% of the 132 patients with an asystolic reflex. These latter patients had both asystole ≥3 s (mean 7.6±2.2 s) and SBP fall to 63±22 mm Hg: in 46 (28%) patients, symptoms persisted after atropine (mixed form), in the remaining 86 (52%) patients, symptoms did not (cardioinhibitory form) persist. Conclusions-The current definition of ≥50 mm Hg SBP fall failed to identify one third of patients with isolated vasodepressor form. A cut-off value of symptomatic SBP of ≤85 mm Hg seems more appropriate, but it is unable to identify cardioinhibitory forms. In asystolic forms, atropine testing is able to distinguish a cardioinhibitory form from a mixed form. (Circ Arrhythm Electrophysiol. 2014;7:505-510.)

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Carotid sinus hypersensitivity and syncope

Cited by 149 publications

References 21 publications

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

Nasal carcinoma – a rare indication for a permanent pacemaker

Assessment of the Vasodepressor Reflex in Carotid Sinus Syndrome

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