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How reproducible is the cardioinhibitory response to carotid sinus massage in fallers?
D A Richardson1, R Bexton, F E Shaw
1Cardiovascular Investigation Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK.
Insights
Cardioinhibitory carotid sinus hypersensitivity (CICSH) is reproducible in most fallers, especially soon after initial testing. However, the specific response to carotid sinus massage (CSM) varies by side and position.
Area of Science:
- Cardiology
- Geriatrics
- Neurology
Background:
- Recurrent falls in older adults are a significant health concern.
- Carotid sinus hypersensitivity (CICSH) is a potential cause of syncope and falls.
- The reproducibility of CICSH has been questioned, impacting diagnostic and treatment decisions.
Purpose of the Study:
- To evaluate the reproducibility of the cardioinhibitory subtype of carotid sinus hypersensitivity (CICSH) in patients experiencing falls.
- To determine the consistency of CICSH responses over time and under different testing conditions.
Main Methods:
- A cohort of 175 patients with CICSH and unexplained falls were randomized.
- A subset of 64 control subjects underwent carotid sinus massage (CSM) on four separate occasions over one year.
- CSM was performed supine and upright, on both sides, with standardized technique.
Main Results:
- CICSH was demonstrated in 82% of all CSM tests.
- Reproducible CICSH was observed in 91% of subjects initially, decreasing to 70% at one year.
- Only 17% of subjects showed a consistent response on the same side and in the same position across all tests.
Conclusions:
- CICSH is reproducible in the majority of fallers, particularly in the period shortly after initial diagnosis.
- The specific cardioinhibitory response during CSM is inconsistent regarding the side of stimulation and patient position.
- These findings highlight the need for careful interpretation of CSM results in the context of patient falls.
Aims:
To ascertain the reproducibility of the cardioinhibitory subtype of carotid sinus hypersensitivity (CICSH) in fallers.
Methods And Results:
One hundred and seventy-five subjects with CICSH and unexplained or recurrent falls were randomized to pacemaker implantation or control. Sixty-four control subjects (61% female, mean age 71.8 years, median 2 falls in the previous year) completed one-year follow-up and had carotid sinus massage (CSM) performed on 4 occasions (twice before randomization, at 6 months and 1 year following randomization). CSM was performed sequentially on the right and then left sides, initially supine and then upright at 70 degrees head-up tilt by the same investigator. On each occasion CSM was discontinued once CICSH was demonstrated. CICSH was demonstrated on 82% of occasions, 75% on right CSM and 77% whilst the subject was supine. Before randomization, and at 6 months and 1 year, 91%, 67%, and 70% of subjects had reproducible CICSH respectively. Half had CICSH on all 4 occasions. Only 17% had a consistent response on the same side in the same position.
Conclusions:
In the majority of subjects CICSH is reproducible and this is more likely shortly after the initial response. However the cardioinhibitory response to CSM is inconsistent both in side elicited and subject position.
