[Value and limitations of carotid sinus massage in healthy elderly individuals. Evaluation of diagnostic criteria for hypersensitive carotid sinus syndrome]

Abstract

Objective: To study the value and limitations of carotid sinus massage in healthy individuals older then 50 years of age, in order to assess the validity of the widely used criteria for the diagnosis of hypersensitive carotid sinus syndrome.

Methods: Right and left carotid sinus massage was performed in 120 healthy individuals older then 50 years of age (74 males and 46 females aged 59 +/- 7 years) who had no prior history of syncope, pre-syncope, or abnormal bradyarrhythmia, during EKG monitoring.

Results: Hypersensitivity of the carotid sinus (HSCS) defined as a pause > 3 s, was found in 28 individuals (23.3%). The pause was induced by right carotid sinus massage in 20 cases and by left carotid sinus massage in 8 cases. Patients demonstrating HSCS were older compared to those who did not develop a pause. One or multiple blocked P wave was seen in 16 cases when carotid sinus massage was performed on the left side compared to 8 with right carotid sinus massage.

Conclusion: In healthy individuals older than 50 years of age, it is not rare to induce a significant pause following carotid sinus massage. This limits the validity of the widely used criteria for the diagnosis of hypersensitive carotid sinus syndrome. Additional criteria are proposed to make this diagnosis in front of a brief loss of consciousness.