Results of carotid sinus massage in a tertiary referral unit--is carotid sinus syndrome still relevant?
BACKGROUND
carotid sinus hypersensitivity (CSH) is associated with syncope, drop attacks and unexplained falls in older people. However, a recent study has also reported a prevalence of 35% in asymptomatic community-dwelling older people.


OBJECTIVE
we conducted a retrospective observational study to investigate the haemodynamic and symptom responses of a large cohort of patients undergoing carotid sinus massage (CSM).


METHODS
the electronically stored haemodynamic data of 302 consecutive patients, aged 71 +/- 11 years, investigated with CSM for unexplained falls and syncope was analysed. Bilateral sequential CSM was performed in the supine and upright positions with continuous electrocardiogram (ECG) and non-invasive beat-to-beat blood pressure monitoring (Taskforce, CN Systems, Austria). CSH (CSH) was defined by maximal R-R interval > or =3 s (cardioinhibitory) and/or a systolic blood pressure drop of > or =50 mmHg (vasodepressor).


RESULTS
a total of 74/302 (25%) subjects had CSH, 37 (50%) of which were cardioinhibitory (CI) and 37 (50%) were vasodepressor (VD) subtypes. Subjects with positive CSM were significantly older (75.2 vs 70.2 years, P < 0.001), and more likely to be male (32% vs 19%, P < 0.01). CSH was diagnosed with right-sided CSM alone in 45 (61%) subjects and erect CSM only in 36 (49%) subjects. Symptom reproduction was more likely with the CI than the VD subtypes (82% vs 28%; P < 0.001).


CONCLUSIONS
CSH was diagnosed in 25% of patients investigated with CSM at our specialist unit, lower than the prevalence of 39% reported for community-dwelling older individuals. This discrepancy may be explained by selection bias and demographic differences, but raises the possibility of CSH being an age-related epiphenomenon rather than a causal mechanism for syncope, drop attacks and unexplained falls. Our observations have important implications for clinical practice and the development of future research strategies.
Tan
Maw Pin
MP
Institute for Ageing and Health, Wolfson Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE4 5PL, UK.
Newton
Julia L
JL
Reeve
Pam
P
Murray
Alan
A
Chadwick
Tom J
TJ
Parry
Steve W
SW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001795:Blood Pressure Determination / Q000009:adverse effects; D002346:Carotid Sinus / Q000503:physiopathology*; D003937:Diagnosis, Differential; D004244:Dizziness / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D004562:Electrocardiography / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008405:Massage; D008875:Middle Aged; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013575:Syncope / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D013577:Syndrome; D018667:Tilt-Table Test