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Carotid sinus hypersensitivity and syncope.

P F Walter, I S Crawley, E R Dorney

    The American Journal of Cardiology
    |September 1, 1978
    PubMed
    Summary
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    Carotid sinus reflex hyperactivity is common in older men, often causing syncope. Pacemakers can help cardioinhibitory types, especially with recurrent syncope, improving diagnosis and treatment.

    Area of Science:

    • Cardiology
    • Geriatrics
    • Neurology

    Background:

    • Hyperactivity of the carotid sinus reflex is frequently observed in elderly males.
    • Diagnosing carotid sinus syncope is challenging due to nonspecific symptoms and the commonality of both reflex hyperactivity and syncope.

    Purpose of the Study:

    • To evaluate episodes of lightheadedness or syncope in men with a hypersensitive carotid sinus reflex.
    • To identify diagnostic and therapeutic strategies for carotid sinus syncope.

    Main Methods:

    • Evaluation of 21 men experiencing lightheadedness or syncope.
    • Carotid sinus reflex testing, including repeated stimulation after atropine administration.
    • Electrophysiologic studies in patients with the cardioinhibitory type.

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    Main Results:

    • Seventeen patients exhibited the cardioinhibitory type, two the vasodepressor type, and two had both types.
    • Permanent pacemaker insertion benefited patients with the cardioinhibitory type and multiple syncope episodes.
    • History of syncope linked to carotid sinus stimulation aided patient selection for pacing.
    • Combined cardioinhibitory and vasodepressor types may be overlooked without repeat testing post-atropine.
    • Electrophysiologic studies indicated intrinsic sinus nodal dysfunction is unlikely to be the primary cause of asystole post-stimulation.

    Conclusions:

    • Pacemaker implantation is an effective treatment for recurrent cardioinhibitory carotid sinus syncope in older men.
    • Careful diagnostic evaluation, including repeated carotid sinus stimulation, is crucial for accurate diagnosis, especially for mixed types.
    • Intrinsic sinus node dysfunction is not the main driver of asystole in this patient group.