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Sinus node electrogram in patients with the hypersensitive carotid sinus syndrome.

E S Gang, D S Oseran, W J Mandel

    Journal of the American College of Cardiology
    |June 1, 1985
    PubMed
    Summary
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    Hypersensitive carotid sinus syndrome causes significant heart rhythm changes during carotid sinus massage, including sinus node arrest. Atropine effectively reversed these effects, suggesting acetylcholine sensitivity.

    Area of Science:

    • Cardiology
    • Electrophysiology
    • Autonomic Nervous System

    Background:

    • Unexplained syncope can be linked to the cardioinhibitory form of hypersensitive carotid sinus syndrome.
    • Standard electrophysiologic evaluation may not reveal sinus node dysfunction in these patients.

    Purpose of the Study:

    • To investigate the direct effects of carotid sinus massage on sinus node function in patients with hypersensitive carotid sinus syndrome.
    • To characterize the electrophysiologic changes occurring during carotid sinus massage in this patient group.

    Main Methods:

    • Direct sinus node electrograms were recorded using transvenous electrode catheters in two patients.
    • Sinus node potentials were continuously monitored during carotid sinus massage.
    • Electrophysiologic responses were assessed before, during, and after carotid sinus massage, with and without atropine administration.

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    Main Results:

    • Carotid sinus massage induced significant sinoatrial conduction abnormalities, including prolonged sinoatrial time, slowed depolarization, sinoatrial exit block, and sinus node arrest.
    • Post-massage, sinus node potentials did not immediately follow atrial impulses, with prolonged sinoatrial times and P wave changes observed.
    • Intravenous atropine (1.0 mg) completely abolished the abnormal responses to carotid sinus massage.

    Conclusions:

    • Carotid sinus massage triggers profound sinoatrial conduction disturbances and sinus node arrest in hypersensitive carotid sinus syndrome.
    • These autonomic-mediated effects, including pacemaker site shifts, are reversible with atropine.
    • Findings suggest denervation sensitivity to acetylcholine may underlie these cardiovascular responses.