Value of programmed ventricular stimulation in presumed carotid sinus syndrome.
This study determines the results of programmed stimulation in patients with syncope or near-syncope presumed to have the carotid sinus syndrome based on the finding of carotid sinus hypersensitivity and the absence of any other apparent cause for syncope or near-syncope after clinical evaluation. Fourteen patients had coronary artery disease, 1 had dilated cardiomyopathy and 18 patients did not have structural heart disease. Programmed simulation was performed at 2 basic drive cycle lengths and 2 right ventricular sites with 1 to 3 extrastimuli. Sustained unimorphic ventricular tachycardia (VT) was induced in 5 of 15 patients who had structural heart disease, and in none of the 18 patients who did not (p less than 0.05). Polymorphic VT or ventricular fibrillation (VF) was induced in 5 of 15 patients (33%) who had structural heart disease, and in 5 of 18 patients (27%) who did not (p greater than 0.05). Patients who had inducible unimorphic VT were treated with antiarrhythmic drugs that suppressed the induction of VT, and 4 of 5 patients also received a pacemaker; no patient had a recurrence of syncope during follow-up. Patients who had inducible polymorphic VT and VF (n = 10) or no inducible VT (n = 18) received treatment directed at only carotid sinus syndrome. Two patients with inducible VT or VF and 1 patient without inducible VT had recurrent syncope during follow-up, but none had cardiac arrest or died suddenly.(ABSTRACT TRUNCATED AT 250 WORDS)
Nelson
S D
SD
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor.
Kou
W H
WH
De Buitleir
M
M
DiCarlo
L A
LA
Morady
F
F
D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial; D002346:Carotid Sinus / Q000503:physiopathology*; D004558:Electric Stimulation; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010812:Physical Stimulation; D013575:Syncope / Q000503:physiopathology*; D013577:Syndrome; D013610:Tachycardia / Q000209:etiology / Q000503:physiopathology