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Europace 2004 6(4):292-295; doi:10.1016/j.eupc.2004.03.002
© 2004 by European Society of Cardiology
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CASE REPORT

Carotid sinus massage during evaluation for transient loss of consciousness: just a positive test?

Cengiz Ermis and David G. Benditt* 1

Cardiac Arrhythmia Center, Cardiovascular Division, University of Minnesota Medical School MMC 508, 420 Delaware Street SE, Minneapolis, MN 55455, United States

An electrocardiographic recording obtained during diagnostic evaluation of recurrent transient loss of consciousness in a 53-year-old man is presented. Carotid sinus massage (CSM), having elicited a ventricular asystole of >5 s duration was deemed to have provided a possible diagnostic basis for syncope. However, apart from the pause and somewhat unexpectedly, CSM also suppressed preexisting frequent ventricular ectopy. Explanations for this unexpected finding can only be considered speculative, but include direct CSM-induced parasympathetic suppression of ectopic activity at intra-ventricular pacemaker sites, concomitant diminution of sympathetic neural activity at ectopic sites, or interruption of ‘linking’ of normal ventricular activation to initiation of premature ventricular contractions.

Key Words: carotid sinus massage, syncope, ventricular ectopy

*Corresponding author. Tel.: +1-612-625-4401; fax: +1-612-624-4937. E-mail address: bendi001{at}tc.umn.edu (D.G. Benditt).


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