© 2002 by European Society of Cardiology
How reproducible is the cardioinhibitory response to carotid sinus massage in fallers?
1Cardiovascular Investigation Unit, Royal Victoria Infirmary, University of Newcastle Upon Tyne Newcastle Upon Tyne, U.K.; 2Regional Cardiothoracic Unit, Freeman Hospital, University of Newcastle Upon Tyne Newcastle Upon Tyne, U.K.; 3Centre for Health Services Research, University of Newcastle Upon Tyne Newcastle Upon Tyne, U.K.
AIMS: To ascertain the reproducibility of the cardioinhibitory subtype of carotid sinus hypersensitivity (CICSH) in fallers.
METHODS AND RESULTS: One hundred and seventy-five subjects with CICSH and unexplained or recurrent falls were randomized to pacemaker implantation or control. Sixty-four control subjects (61% female, mean age 71·8 years, median 2 falls in the previous year) completed one-year follow-up and had carotid sinus massage (CSM) performed on 4 occasions (twice before randomization, at 6 months and 1 year following randomization). CSM was performed sequentially on the right and then left sides, initially supine and then upright at 70° head-up tilt by the same investigator. On each occasion CSM was discontinued once CICSH was demonstrated.
CICSH was demonstrated on 82% of occasions, 75% on right CSM and 77% whilst the subject was supine. Before randomization, and at 6 months and 1 year, 91%, 67%, and 70% of subjects had reproducible CICSH respectively. Half had CICSH on all 4 occasions. Only 17% had a consistent response on the same side in the same position.
CONCLUSIONS: In the majority of subjects CICSH is reproducible and this is more likely shortly after the initial response. However the cardioinhibitory response to CSM is inconsistent both in side elicited and subject position.
Key Words: Reproducibility, carotid sinus massage, cardioinhibitory carotid sinus hypersensitivity
Correspondence: Professor R. A. Kenny MD FRCPI FRCP, Professor of Cardiovascular research, Head of Department of Geriatric Medicine, Cardiovascular Investigation Unit, Royal Victoria Infirmary and School of Clinical Sciences, University of Newcastle Upon Tyne, Queen Victoria Road, Newcastle Upon Tyne NE1 4LP, U.K. Tel.: 0191 232 5131 Ext. 25894. Fax: 0191 222 5638; E-mail: R.A.Kenny{at}ncl.ac.uk Financial support: this study was supported by a grant from the National Cardiovascular Research and Development Grant Fund, U.K. and Research into Ageing. Additional financial support was provided by Medtronic Pacemaker Company (Medtronic Inc., Brady IPG Research, MS T310, 7000 Central Avenue, N.E., Minneapolis MN 55432, U.S.A.).
[1] McIntosh S, Lawson J, Kenny RA. Clinical characteristics of vasodepressor, cardioinhibitory and mixed carotid sinus syndrome in the elderly. Am J Med 1993; 95: 203–208.[CrossRef][Web of Science][Medline]
[2] Podczek A, Frohner K, Meisl F, Unger G, Steinbach K. Significance of carotid sinus massage in patients with cerebrovascular symptoms. Pacing Clin Electrophysiol 1983; 6: A–17 (Abstract).
[3] Brignole M, Menozzi C, Lolli G, Bottoni N, Gaggioli G. Long-term outcome of paced and nonpaced patients with severe carotid sinus syndrome. Am J Cardiol 1992; 69: 1039–1043.[CrossRef][Web of Science][Medline]
[4] McIntosh S, DaCosta D, Kenny RA. Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a syncope clinic. Age Ageing 1993; 22: 53–58.
[5] Richardson DA, Bexton RS, Shaw FE, Bond J, Kenny RA. Prevalence of cardioinhibitory carotid sinus hypersensitivity (CICSH) in accident and emergency attendances with falls or syncope. Pacing & Clinical Electrophysiology 1997; 20: 820–823.
[6] Kenny RA, Richardson DA, Steen N, Bexton RS, Shaw FE, Bond J. Carotid sinus syndrome: A modifiable risk factor for non-accidental falls in older adults (SAFE–PACE). J Am Coll Cardiol 2001; 38: 1491–1496.
[7] Kenny RA and Dunn HM. Carotid sinus massage in carotid sinus syndrome. Ulster Med J 1990; 59: 93–95.[Web of Science][Medline]
[8] Peretz DI, Gerein AN, Miyagishima RT. Permanent demand pacing for hypersensitive carotid sinus syndrome. J Can Med Assoc 1973; 108: 1131–1134.[Medline]
[9] Walter PF, Crawley IS, Dorney ER. Carotid sinus hypersensitivity and syncope. Am J Cardiol 1978; 42: 396–403.[CrossRef][Web of Science][Medline]
[10] Wentnik JRM, Jansen RWMM, Hoefnagels WHL. The influence of age on the response of blood pressure and heart rate to carotid sinus massage in healthy volunteers. Cardiol Elderly 1993; 1: 453–459.
[11] Brignole M, Gigli G, Altomonte F, et al. Il riflesso cardioinhibitore provocato dalla stimulazione del seno carotideo nei soggetti normali e con malattie cardiovascolari. G Ital Cardiol 1985; 15: 514–519.[Medline]
[12] Morley CA, Perrins EJ, Sutton R. Is there a difference between carotid sinus syndrome and sick sinus syndrome? Eur J Cardiac Pacing Electrophysiol 1991; 1: 62–70.
[13] Thomas JE. Hyperactive carotid sinus reflex and carotid sinus syncope. Mayo Clin Proc 1969; 44: 127–139.[Web of Science][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||