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Results of carotid sinus massage in a tertiary referral unit - is carotid sinus syndrome still relevant?

Lookup NU author(s): Dr Maw Tan, Professor Julia Newton, Professor Alan Murray, Dr Thomas Chadwick, Dr Steve Parry

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Abstract

Objective: we conducted a retrospective observational study to investigate the haemodynamic and symptom responses of a large cohort of patients undergoing carotid sinus massage (CSM). Methods: the electronically stored haemodynamic data of 302 consecutive patients, aged 71 +/- 11 years, investigated with CSM for unexplained falls and syncope was analysed. Bilateral sequential CSM was performed in the supine and upright positions with continuous electrocardiogram (ECG) and non-invasive beat-to-beat blood pressure monitoring (Taskforce (TM), CN Systems, Austria). CSH (CSH) was defined by maximal R-R interval >= 3 s (cardioinhibitory) and/or a systolic blood pressure drop of >= 50 mmHg (vasodepressor). Results: a total of 74/302 (25%) subjects had CSH, 37 (50%) of which were cardioinhibitory (CI) and 37 (50%) were vasodepressor (VD) subtypes. Subjects with positive CSM were significantly older (75.2 vs 70.2 years, P < 0.001), and more likely to be male (32% vs 19%, P < 0.01). CSH was diagnosed with right-sided CSM alone in 45 (61%) subjects and erect CSM only in 36 (49%) subjects. Symptom reproduction was more likely with the CI than the VD subtypes (82% vs 28%; P < 0.001). Conclusion: CSH was diagnosed in 25% of patients investigated with CSM at our specialist unit, lower than the prevalence of 39% reported for community-dwelling older individuals. This discrepancy may be explained by selection bias and demographic differences, but raises the possibility of CSH being an age-related epiphenomenon rather than a causal mechanism for syncope, drop attacks and unexplained falls. Our observations have important implications for clinical practice and the development of future research strategies.


Publication metadata

Author(s): Tan MP, Newton JL, Reeve P, Murray A, Chadwick TJ, Parry SW

Publication type: Article

Publication status: Published

Journal: Age and Ageing

Year: 2009

Volume: 38

Issue: 6

Pages: 680-686

ISSN (print): 0002-0729

ISSN (electronic): 1468-2834

Publisher: Oxford University Press

URL: http://dx.doi.org/10.1093/ageing/afp160

DOI: 10.1093/ageing/afp160


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