Carotid sinus hypersensitivity in patients referred with possible epilepsy

Four patients with recurrent transient loss of consciousness, all of whom had previously undergone extensive non-invasive cardiological investigations, were referred for neurological opinion. All were found to exhibit a resting bradycardia and a cardioinhibitory response to carotid sinus stimulation. All were referred for cardiological opinion but only two patients were considered by their respective cardiologists to warrant pacemaker implantation. Those who did not receive a pacemaker continue to suffer from their symptoms. The clinical management of these patients highlights an apparent divergence of opinion amongst cardiologists on the treatment of carotid sinus hypersensitivity and emphasises that, unless the ECG and blood pressure responses to carotid sinus stimulation are observed in patients with histories of unexplained episodes of altered consciousness, carotid sinus hypersensitivity will be missed as a possible cause of symptoms. The presence of unexplained bradycardia may suggest carotid sinus hypersensitivity.