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Europace Advance Access originally published online on November 5, 2008
Europace 2008 10(12):1400-1405; doi:10.1093/europace/eun278
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Syncope

The relationship between carotid sinus hypersensitivity, orthostatic hypotension, and vasovagal syncope: a case–control study

Maw Pin Tan1,2, Julia L. Newton1,2, Tom J. Chadwick3 and Steve W. Parry1,2,*

1 Institute for Ageing and Health, Wolfson Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; 2 Falls and Syncope Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK; 3 Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne NE2 4AA, UK

Aims: Previous uncontrolled studies reported an overlap between carotid sinus hypersensitivity (CSH), vasovagal syncope (VVS), and orthostatic hypotension (OH). We conducted a case–control study evaluating this relationship in a large patient cohort.

Methods and results: The electronically stored continuous electrocardiograph and blood pressure (BP) measurements for active stand and head-up tilt-table (HUT) tests of 302 consecutive patients investigated with carotid sinus massage (CSM) were analysed. Carotid sinus hypersensitivity was defined as ≥3 s asystole and/or systolic BP (SBP) drop of ≥50 mmHg during CSM. Orthostatic hypotension was defined as BP reductions of ≥20 mmHg systolic or of ≥10 mmHg diastolic, whereas VVS was diagnosed with a positive HUT test. There was no significant difference in the number of subjects with OH (57 vs. 55%; P = 0.778) or HUT-positive VVS (45 vs. 47%; P = 0.828) between cases with CSH and controls without CSH. Carotid sinus hypersensitivity subjects had significantly larger SBP reduction (P = 0.039) and longer time to nadir (P = 0.007) during active stand, and trends to vasodepressor (P = 0.071) and dysautonomic responses to HUT (P = 0.151).

Conclusion: Carotid sinus hypersensitivity, OH, and VVS are common conditions affecting patients with syncope and falls which are likely to co-exist in such individuals. The differences in haemodynamic response patterns to active stand and HUT in CSH subjects could be the result of an age-associated delay in sympathetic responses.

Key Words: Syncope, Carotid sinus hypersensitivity, Vasovagal, Orthostatic hypotension, Carotid sinus massage, Tilt-table test

* Corresponding author.Tel: +44 191 282 5237; fax: +44 191 282 5338.E-mail address: swparry{at}hotmail.com

Manuscript submitted 4 July 2008. Accepted after revision 16 September 2008.


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