Natural and unnatural history of patients with severe carotid sinus hypersensitivity: a preliminary study.
Natural history of patients with symptomatic severe carotid sinus hypersensitivity is not clearly known. In order to evaluate the effectiveness of pacing therapy in these patients we performed a randomized treatment/no-treatment prospective study in 35 patients. They were randomly assigned to two groups: 19 patients received no therapy, 16 patients received a VVI (#11) or DDD (#5) pacemaker implant. During the 8.4 +/- 4.3 month follow-up period patients receiving no therapy had recurrence of syncope in 9 cases (47%) and minor symptoms in 13 (68%); at the 16th month, actuarial curve showed absence of syncope in 36% of patients and of any symptoms in 30%. During the 7.2 +/- 4.1 month follow-up period, the patients receiving the pacemaker implant had no recurrence of syncope, minor symptoms in three (19%); at the 16th month, actuarial curve showed absence of syncope in 100% of patients and of any symptoms in 78%. During follow-up, 12 patients in no-treatment group received a pacemaker implant because of the recurrence of severe symptoms; successively they had a strong reduction of symptoms. In conclusion, this study definitively demonstrates that patients with severe symptomatic carotid sinus hypersensitivity had a high rate of recurrence of spontaneous symptoms and that in these patients cardiac pacing is a useful therapy.
Brignole
M
M
Laboratory of Electrophysiology and Pacing, Hospital of Lavagna, Genoa, Italy.
Menozzi
C
C
Lolli
G
G
Sartore
B
B
Barra
M
M
D000368:Aged; D002346:Carotid Sinus / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D011897:Random Allocation; D012008:Recurrence; D012021:Reflex, Abnormal / Q000150:complications* / Q000628:therapy; D013575:Syncope / Q000209:etiology* / Q000628:therapy; D013577:Syndrome