Abstract
In Reply. —Dr Landau points out the risks of carotid sinus massage in elderly patients and warns that massage of the carotid sinus region carries a risk of permanent impairment and death. Indeed, there have been case reports of prolonged asystole, stroke, and ventricular fibrillation associated with carotid sinus massage. In many of these reports, the patients were quite ill or carotid massage was performed for as long as 15 seconds. In carefully selected patients without previous cerebral vascular disease or cardiac conduction disease, this procedure has been done quite safely, as long as the duration of massage does not exceed 5 seconds. There have been several studies suggesting that carotid sinus hypersensitivity may account for as many as one quarter to one half of episodes of unexplained falls and syncope in the elderly. 1,2 One study of 100 elderly nursing home patients showed that those with carotid sinus hypersensitivity had twice
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