Use of serotonin re-uptake inhibitors as primary therapy for carotid sinus hypersensitivity

Carotid sinus syndrome (CSS) is a well-recognized cause of unexplained syncope in older patients, and may lead to significant morbidity related to trauma suffered during falls. Dual chamber pacing has been demonstrated to be efficacious in relieving symptoms due to bradycardia, but not the accompanying vasodepressor response. We report three patients with recurrent syncope due to a mixed type of CSS, who were treated with serotonin re-uptake inhibitors (SSRIs) alone, and were symptom-free after 4-5 weeks of therapy. The patients have remained symptom-free after more than 13 months of treatment. We conclude that SSRIs may be potentially useful in the treatment of CSS, and that the central mechanisms involved in CSS may be similar to those that result in neurocardiogenic syncope.