Results and complications of the carotid sinus massage performed according to the “method of symptoms”

Teste de inclinação (Tilt-test): do necessário ao imprescindível

“…If the BP is intermittently measured, the interval between measurements should be as small as possible, especially in the phase that is close to the positive result of the test. In patients aged over 40 and with a clinical history of syncope, the carotid sinus massage is also recommended, because during tilting, the sensitivity of this technique is higher, and it is also possible to evaluate the vasodepressor component 24 . The test can be carried out at any time of day, but when the goal is to study the reproducibility of results, it is important to repeat the test at the same time it is was previously carried out 25 .…”

“…The massage during tilt allows diagnosing half of the patients with the disease that would not be diagnosed if the procedure was performed only in a supine position. In a retrospective study with 1,719 patients, the diagnosis of carotid sinus hypersensitivity was made in 226 cases during the procedure in the supine position and in 217 cases only after repeating the procedure at a tilted position 24 . In addition, the continuous monitoring of BP during the HUTT makes it easier to evaluate the vasodepressor component, which is important for the diagnosis because, in most cases, syncope results both from the drop in HR and the decrease in BP -mixed response.…”

Incidência de complicações relacionadas à massagem do seio carotídeo em 502 pacientes ambulatoriais

“…The maneuver can cause prolonged periods of asystole, interrupted by escape beats, Many case series have been published on the safety of the CSM 5-9 and more than 10,000 patients were submitted to the CSM in these studies. None of these series reported episodes of malignant ventricular arrhythmia or prolonged asystole that needed medical intervention [5][6][7][8][9] . However, isolated cases of patients that developed ventricular fibrillation have been described 11 .…”

“…This incidence of complications (4‰) did not significantly differ from the one described in 5 large case series 5,9 (Table 1). In these studies, 10,711 patients were submitted to approximately 42,000 CSM and only 35 presented complications (3.2 neurological complications per 1,000 patients) [5][6][7][8][9] . The incidence of complications with sequelae was even lower (0.74‰) [5][6][7][8][9] .…”

“…In five large case series (Table 1), no cardiologic complication related to the procedure were observed [5][6][7][8][9] . In these series, the incidence of cerebrovascular complications of the CSM was also small, varying from 1.7‰ to 9‰ [5][6][7][8][9] . The present study is the first one carried out of the European continent with the objective of evaluating the incidence of CSM-related complications in outpatients aged ≥50 years and with a high prevalence of structural cardiopathy and atherosclerotic disease.…”