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[Carotid sinus syndrome and sick sinus syndrome: 2 frequent and distinct indications for pacemaker implantation]
M Brignole1, C Menozzi, G Lolli
1Laboratorio di elettrofisiologia ed impianto pacemaker, Servizio di Cardiologia, Ospedali Riuniti, Lavagna.
Insights
Carotid sinus syndrome is a common reason for pacemaker implantation, similar to sick sinus syndrome. Distinguishing between these conditions is important, even though they often occur together.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Carotid sinus syndrome (CSS) and vasovagal syncope patients are increasingly considered for pacemaker implantation.
- The precise incidence of CSS and its relationship with sick sinus syndrome (SSS), with which it is often associated or confused, is not well-established.
Purpose of the Study:
- To determine the incidence of CSS and SSS as indications for pacemaker implantation.
- To compare the clinical characteristics of patients with CSS versus SSS.
Main Methods:
- Retrospective analysis of 298 consecutive pacemaker implants.
- Categorization of implants based on indication: CSS, SSS, or both.
- Comparison of patient demographics and clinical features between CSS and SSS groups.
Main Results:
- 12% of implants were for CSS (36 patients), 11% for SSS (33 patients), and 8% for both (24 patients).
- CSS patients exhibited higher syncope prevalence (97% vs. 42%), more syncopal episodes, and fewer associated cardiac diseases compared to SSS patients.
- CSS patients were more frequently indicated for VVI pacing (75% vs. 3%) and had lower rates of cardiac enlargement, heart failure, and atrial fibrillation.
Conclusions:
- CSS is a frequent indication for cardiac pacing, comparable to SSS.
- Despite association in about one-third of patients, distinguishing CSS from SSS is clinically justified.
- Understanding these differences aids in appropriate patient selection and pacing strategy.
Unlabelled:
At present, patients affected by carotid sinus syndrome and, more general by speaking, by vasovagal syncopes, are being considered more and more for pacemaker implant. However, neither the real incidence of the carotid sinus syndrome or its relation with the sick sinus syndrome with which it is often associated or even confused is precisely known. Of a total of 298 consecutive pacemaker implants, 36 (12%) were executed for carotid sinus syndrome, 33 (11%) for sick sinus syndrome and 24 (8%) for both. The annual incidence was respectively of 40, 37 and 26 implants per year/million of inhabitants. Patients affected by carotid sinus syndrome, when compared with those affected by sick sinus syndrome, showed: a higher prevalence of syncopes (97 vs 42%) more syncopal episodes per patient (2.9 +/- 2 vs 1.8 +/- 0.9), a lower prevalence of associated cardiac diseases (53 vs 100%), cardiac enlargement (36 vs 88%), heart failure (6 vs 36%) and paroxysmal atrial fibrillation (0 vs 97%), a more frequent indication to VVI pacing (75 vs 3%). Generally, when both syndromes were present, the patients showed intermediate characteristics.
In Conclusion:
carotid sinus syndrome is a frequent indication of cardiac pacing as sick sinus syndrome; even if an association is present in about one third of patients, a distinction between carotid sinus syndrome and sick sinus syndrome is justified by theoretical and practical considerations.