Carotid sinus pressure: a new application of an old maneuver. A preliminary report

Area of Science:

• Cardiology
• Electrophysiology

Background:

• Atrial fibrillation frequently presents with wide QRS-complexes.
• Distinguishing aberrant ventricular conduction from ventricular ectopy is clinically important.

Purpose of the Study:

• To evaluate the efficacy of carotid sinus pressure (CSP) in differentiating aberrant ventricular complexes from ventricular ectopy in atrial fibrillation patients.

Main Methods:

• Carotid sinus pressure (CSP) was applied during ECG monitoring in nine patients with atrial fibrillation and frequent wide QRS-complexes.
• The response to CSP was assessed by changes in ventricular rate and wide QRS-complexes.
• Adenosine and/or lidocaine boluses were used to verify the origin of wide QRS-complexes.

Main Results:

• CSP successfully resolved aberrant beats in 85.7% of patients (6/7).
• The technique demonstrated high specificity (100%), accuracy (88.9%), and predictive value (100%).

Conclusions:

• Carotid sinus pressure (CSP) is a reliable and simple bedside method for distinguishing aberrant ventricular complexes from ventricular ectopy in atrial fibrillation.
• This technique aids in clarifying the origin of wide QRS-complexes.