Skip Navigation



Europace Advance Access published online on May 16, 2007
Europace, doi:10.1093/europace/eum092
This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
9/8/563    most recent
eum092v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Maggi, R.
Right arrow Articles by Grovale, N.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Maggi, R.
Right arrow Articles by Grovale, N.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Cardioinhibitory carotid sinus hypersensitivity predicts an asystolic mechanism of spontaneous neurally mediated syncope

Roberto Maggi1, Carlo Menozzi2, Michele Brignole1,*, Cristian Podoleanu1, Matteo Iori2, Richard Sutton3, Angel Moya4, Franco Giada5, Serafino Orazi6 and Nicoletta Grovale7

1 Department of Cardiology, Arrhythmologic Centre, Ospedali del Tigullio, Via don Bobbio 24, 16033 Lavagna, Italy; 2 Department of Cardiology, Ospedale S Maria Nuova, Reggio Emilia, Italy; 3 Department of Cardiology, Royal Brompton & Harefield Hospitals, London, UK; 4 Department of Cardiology, Hospital General Vall d'Hebrón, Barcelona, Spain; 5 Department of Cardiology, Ospedale Umberto I, Mestre, Italy; 6 Department of Cardiology, Ospedale S. Camillo De Lellis, Rieti, Italy; 7 Medtronic Inc., Rome, Italy

Aims We correlated the finding of cardioinhibitory carotid sinus hypersensitivity (CSH) with that observed during a spontaneous syncopal relapse by means of an implantable loop recorder (ILR).

Methods and results We included 18 consecutive patients with suspected recurrent neurally mediated syncope and positive cardioinhibitory response during carotid sinus massage (max pause 5.5 ± 1.6 s) who had subsequent documentation of a spontaneous syncope by means of an ILR. They were compared with a 2:1 age- and sex-matched group of 36 patients with a clinical diagnosis of recurrent neurally mediated syncope and negative response to carotid sinus massage, tilt testing and ATP test. Asystole >3 s was observed at the time of the spontaneous syncope in 16 (89%) of CSH patients and in 18 (50%) of the control group (P = 0.007). Sinus arrest was the most frequent finding among CSH patients but not among controls (72 vs. 28%, P = 0.003). After ILR documentation, 14 CSH patients with asystole received dual-chamber pacemaker implantation; during 35 ± 22 months of follow-up, 2 syncopal episodes recurred in 2 patients (14%), and pre-syncope occurred in another 2 patients (14%). Syncope burden decreased from 1.68 (95% confidence interval 1.66 – 1.70) episodes per patient per year before to 0.04 (0.038–0.042) after pacemaker implant (98% relative risk reduction).

Conclusions In patients with suspected neurally mediated syncope, the finding of cardioinhibitory CSH predicts an asystolic mechanism at the time of spontaneous syncope and, consequently, suggests a possible benefit of cardiac pacing therapy.

Key Words: Syncope, Diagnosis, Electrocardiographic monitoring, Implantable loop recorder, Carotid sinus massage, Carotid sinus hypersensitivity

* Corresponding author. Tel: +39 0185 329569; fax: +39 0185 306506. E-mail address: mbrignole{at}ASL4.liguria.it

Manuscript submitted 25 February 2007. Accepted after revision 9 April 2007.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Eur Heart JHome page
Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), Endorsed by the following societies, European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al.
Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)
Eur. Heart J., November 1, 2009; 30(21): 2631 - 2671.
[Full Text] [PDF]

Home page
 EuropaceHome page
Task Force members, M. Brignole, P. Vardas, E. Hoffman, H. Huikuri, A. Moya, R. Ricci, N. Sulke, W. Wieling, EHRA Scientific Documents Committee, et al.
Indications for the use of diagnostic implantable and external ECG loop recorders
Europace, May 1, 2009; 11(5): 671 - 687.
[Full Text] [PDF]

Home page
 ESC Textbook of Cardiovascular MedicineHome page
M. Brignole, J.-J. Blanc, R. Sutton, and A. Moya
CHAPTER 26 Syncope
ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
M. Brignole, F. Giada, A. Raviele, and J. J. Blanc
Pacing for syncope: what role? which perspective?
Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I37 - I43.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.