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. 2020 Feb;114(2):245-253.
doi: 10.36660/abc.20190008.

Long-Term Mortality in Cardioinhibitory Carotid Sinus Hypersensitivity Patient Cohort

[Article in English, Portuguese]
Gustavo de Castro Lacerda  1   2 , Andrea Rocha de Lorenzo  1   2 , Bernardo Rangel Tura  1 , Marcela Cedenilla Dos Santos  1 , Artur Eduardo Cotrim Guimarães  3 , Renato Côrtes de Lacerda  3 , Roberto Coury Pedrosa  2
Affiliations

Long-Term Mortality in Cardioinhibitory Carotid Sinus Hypersensitivity Patient Cohort

[Article in English, Portuguese]
Gustavo de Castro Lacerda et al. Arq Bras Cardiol. 2020 Feb.

Abstract

Background: Cardioinhibitory carotid sinus hypersensitivity (CICSH) is defined as ventricular asystole ≥ 3 seconds in response to 5-10 seconds of carotid sinus massage (CSM). There is a common concern that a prolonged asystole episode could lead to death directly from bradycardia or as a consequence of serious trauma, brain injury or pause-dependent ventricular arrhythmias.

Objective: To describe total mortality, cardiovascular mortality and trauma-related mortality of a cohort of CICSH patients, and to compare those mortalities with those found in a non-CICSH patient cohort.

Methods: In 2006, 502 patients ≥ 50 years of age were submitted to CSM. Fifty-two patients (10,4%) were identified with CICSH. Survival of this cohort was compared with that of another cohort of 408 non-CICSH patients using Kaplan-Meier curves. Cox regression was used to examine the relation between CICSH and mortality. The level of statistical significance was set at 0.05.

Results: After a maximum follow-up of 11.6 years, 29 of the 52 CICSH patients (55.8%) were dead. Cardiovascular mortality, trauma-related mortality and the total mortality rate of this population were not statistically different from that found in 408 patients without CICSH. (Total mortality of CICSH patients 55.8% vs. 49,3% of non-CICSH patients; p: 0.38).

Conclusion: At the end of follow-up, the 52 CICSH patient cohort had total mortality, cardiovascular mortality and trauma-related mortality similar to that found in 408 patients without CICSH.

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Conflict of interest statement

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Study design and results. CSM: Carotid sinus massage; CICSH: cardioinhibitory carotid sinus hypersensitivity.
Figure 2
Figure 2
Duration of the longest RR interval observed during right and left carotid sinus massage. Boxplots on the left of each square represent patients who died during follow-up. Boxplots on the right represent patients who were alive at the end of the study.
Figure 3
Figure 3
Survival curves of patients with (in blue) and without CICSH (in red) CICSH: Cardioinhibitory carotid sinus hypersensitivity.
Figure 4
Figure 4
Example of a patient with CICSH. ECG of a 58 year-old male with previous percutaneous coronary intervention. He denied syncope in the past. The ECG reveals normal sinus rhythm with heart rate of 60 bpm and T-wave inversion in Lead 3 and aVF. Right carotid sinus massage triggered 6360 seconds of asystole with concomitant fall in blood pressure and pre-syncope. A few minutes later, he was submitted to left carotid sinus massage, no asystole was observed. RCSM: right carotid sinus massage.
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References

    1. Brignole M, Moya A, de Lange F, Deharo JC, Elliott PM, Fanciulli A, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21):1883–1948. - PubMed
    1. Martinelli Filho M, Zimerman LI, Lorga AM, Vasconcelos JTM, Rassi Jr. A. Guidelines for Implantable Electronic Cardiac Devices of the Brazilian Society of Cardiology. Arq Bras Cardiol. 2007;89(6):e210–e238.
    1. Kerr SR, Pearce MS, Brayne C, Davis RJ, Kenny RA. Carotid sinus hypersensitivity in asymptomatic older persons implications for diagnosis of syncope and falls. Arch Intern Med. 2006;166(5):515–520. - PubMed
    1. Freitas J, Santos R, Azevedo E, Carvalho M. Prevalência e perfil clínico da hipersensibilidade do seio carotídeo numa população com síncope inexplicada. Rev Port Cardiol. 2004;23(6):835–840. - PubMed
    1. Peretz D, Abdulla A. Management of cardioinhibitory hypersensitive carotid sinus syncope with permanent cardiac pacing: a seventeen year prospective study. Can J Cardiol. 1985;1(2):86–91. - PubMed

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