The role of pacemaker in hypersensitive carotid sinus syndrome

Abstract

Permanent pacemaker is an effective treatment for CSS. However, the recurrence of symptoms was two- to three-fold more frequent in patients with mixed CSS, probably due to the persistence of vasodepressor component.

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

“…282 Unlike AV block, the results of immunosuppression in patients with VA are controversial. Some studies have shown improvement with immunosuppression, 283 whereas others have shown no benefit and even harm due to worsening VA and aneurysm formation.…”

“…417 Contraindications Syncope recurred in fewer patients treated with pacing than in untreated patients, with observation periods up to 5 years. 420,423 In 3 controlled, open-label trials, the relative risk reduction of syncope recurrence with pacemaker implantation was 76%. 409,[427][428][429] There are no large RCTs.…”

Assessment of the Vasodepressor Reflex in Carotid Sinus Syndrome

“…This quantification of the vasodepressor component is clinically relevant because it has been shown that pacemaker therapy is less effective when the vasodepressor effect is large, compared with that of predominant cardioinhibitory. 11,17,25,26 In an previous study, we found that syncope or presyncope recurred in 12% of patients affected by the dominant cardioinhibitory form and in 58% of those affected by the mixed form. 26 Lopes et al 17 showed that mixed CSS was the only independent predictor of symptom recurrence.…”

“…11,17,25,26 In an previous study, we found that syncope or presyncope recurred in 12% of patients affected by the dominant cardioinhibitory form and in 58% of those affected by the mixed form. 26 Lopes et al 17 showed that mixed CSS was the only independent predictor of symptom recurrence. Moreover, in the absence of a marked vasodepressor effect, most patients with prolonged asystole will benefit from simple, easy-to-implant, and less costly ventricular pacing.…”

“…12,13 To confuse matters further, others have diagnosed a mixed form without eliminating the cardioinhibitory reflex. 4,[14][15][16][17] The length of asystolic pause, which causes symptoms in cardioinhibitory and mixed forms, is generally much longer than the historical 3-s cut-off value adopted in both cardioinhibitory and mixed forms, but no real cut-off value exists (see the Data Supplement). Moreover, no cut-off value in the length of the asystolic reflex is able to distinguish cardioinhibitory from mixed forms.…”