Treatment of Carotid Sinus Hypersensitivity

Abstract

I applaud the initiation of “Cardiovascular Clinics” in the September 1984 issue of the Proceedings and thought that the article “Carotid Sinus Hypersensitivity and Syncope” (pages 637 to 640) was well written and informative. In the discussion, however, I was surprised that no mention was made of carotid sinus denervation as a treatment option. This simple operative procedure, which may be performed with use of local anesthesia, achieves excellent results with minimal associated morbidity.1Trout III, HH Brown LL Thompson JE Carotid sinus syndrome: treatment by carotid sinus denervation.Ann Surg. 1979; 189: 575-580Crossref PubMed Scopus (43) Google Scholar Moreover, long-term administration of anticholinergic drugs or insertion of a pacemaker is avoided. Carotid sinus syncope can occur in patients who have a concomitant hypersensitive carotid sinus and a primary cardiac conduction disturbance. In this setting, cardiac pacing is probably the procedure of choice. In those patients, however, who have syncope or near-syncope associated with a hypersensitive carotid sinus and who have no evidence of a cardiac conduction defect, the treatment of choice is probably carotid sinus denervation. Treatment of Carotid Sinus Hypersensitivity: The authors replyMayo Clinic ProceedingsVol. 60Issue 2PreviewWe are grateful to Dr. Trout for his additional insights into the treatment of carotid sinus hypersensitivity. Carotid sinus denervation has indeed been recognized as a potential therapeutic approach for this syndrome since 1939, when 13 patients who underwent this procedure at the Mayo Clinic were described in a published report.1 The outcome in that group was equivocal, and Dr. Trout is to be congratulated for his improved results.2 We would, however, be reluctant to accept the statement that carotid sinus denervation is the treatment of choice in patients with syncope and a hypersensitive carotid sinus reflex in the absence of a cardiac conduction defect. Full-Text PDF