title: Modified criteria for carotid sinus hypersensitivity are associated with increased mortality in a population-based study.
abstract: OBJECTIVE
  Carotid sinus hypersensitivity (CSH) is arbitrarily defined as ≥3 s asystole or vasodepression of ≥50 mmHg in response to carotid sinus massage (CSM). Using this definition, 39% of older people meet the criteria for CSH. It has been suggested that current criteria are too sensitive. Krediet et al. [The history of diagnosing carotid sinus hypersensitivity: why are the current criteria too sensitive? Europace 2011;13:14-22] and Kerr et al. [Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls. Arch Intern Med 2006;166:515-20] have proposed modified criteria. This population-based study aimed to compare the prevalence of CSH defined according to standard, Krediet and Kerr criteria, and to establish if CSH defined according these criteria is associated with all-cause mortality.
  
  
  RESULTS
  A total of 272 community-dwelling people aged ≥65 were recruited at random. Carotid sinus massage was performed for 5 s in supine and head-up positions. Heart rate and blood pressure response were recorded using an electrocardiogram and photoplethysmography. Cox regression analysis was used to examine the association between each definition of CSH and all-cause mortality. The prevalence of CSH defined according to standard, Krediet, and Kerr criteria was 39, 52, and 10%, respectively. Seventy-one participants died over a mean follow-up of 8.6 years (SD 2.1). Carotid sinus hypersensitivity defined according to standard and Krediet criteria was not associated with survival. Carotid sinus hypersensitivity defined according to Kerr criteria was associated with all-cause mortality independent of age and sex [hazard ratio (HR) 2.023 (95% confidence interval (95% CI) 1.131-3.618) P = 0.018)]. This remained significant after adjusting for cardiovascular risk factors [HR 2.174 (1.075-3.900) P = 0.009].
  
  
  CONCLUSIONS
  Carotid sinus hypersensitivity defined according to Kerr criteria is associated with increased mortality. This raises an interesting question as to the suitability of the current criteria used to define CSH.
authors.affiliation: Faculty of Medical Sciences, Institute of Cellular Medicine, Newcastle University, Clinical Academic Office, M3.100, 3rd Floor Leech Building, Newcastle upon Tyne NE2 4HH, UK Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK Claire.McDonald@ncl.ac.uk.
authors.forename: Claire
authors.initials: C
authors.lastname: McDonald
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Pearce
authors.affiliation: Faculty of Medical Sciences, Institute of Cellular Medicine, Newcastle University, Clinical Academic Office, M3.100, 3rd Floor Leech Building, Newcastle upon Tyne NE2 4HH, UK Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
authors.forename: Julia L
authors.initials: JL
authors.lastname: Newton
authors.affiliation: Faculty of Medical Sciences, Institute of Cellular Medicine, Newcastle University, Clinical Academic Office, M3.100, 3rd Floor Leech Building, Newcastle upon Tyne NE2 4HH, UK Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
authors.forename: Simon R J
authors.initials: SR
authors.lastname: Kerr
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002346:Carotid Sinus / Q000503:physiopathology*; D002423:Cause of Death; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis*; D006336:Heart Massage; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends*; D011187:Posture; D016016:Proportional Hazards Models; D012307:Risk Factors; D019462:Syncope, Vasovagal / Q000175:diagnosis*; D018667:Tilt-Table Test; D006113:United Kingdom
keywords: All-cause mortality; Carotid sinus hypersensitivity; Prevalence