Cardioinhibitory Carotid Sinus Research Articles

Ventricular Pacing as the Preferable Mode for Long‐Term Pacing in Patients with Carotid Sinus Syncope of the Cardioinhibitory Type

This study was designed to determine the efficacy of long-term VVI pacing in patients having the isolated cardioinhibitory type of carotid sinus syncope. The study included 20 patients suffering from repeated syncopal attacks; all were proven by electrophysiological studies to have isolated forms of cardioinhibitory type carotid sinus syncope. Long-term pacing by the VVI mode was carried out in all patients by programming the pacemaker rate well below the patient's sinus rate. The follow-up period after pacemaker implantation, which ranged from 2 to 54 months (average, 20 months), revealed that none of the patients had any recurrence of syncopal attack. Repeated Holter monitoring showed that ten had permanent sinus rhythm without any artificial pacing activity, while in the other ten, pacemaker activity was recorded--predominant in two patients and rare in the other eight. During Holter monitoring, attacks of weakness were reported by four patients; however, they were not related to pacemaker activity. This report indicates the importance of electrophysiological studies in patients suffering from carotid sinus syncope. These studies make possible the diagnosis of the isolated form of cardioinhibitory type syncope for which VVI pacing offers complete relief of symptomatology, thus rendering AV sequential pacing superfluous.

Studies on the differential diagnosis between the primary and secondary cardioinhibitory carotid sinus hypersensitivity.

Studies on the differential diagnosis between the primary and secondary cardioinhibitory carotid sinus hypersensitivity.

Cardioinhibitory carotid sinus hypersensitivity. Intracardiac recordings and clinical assessment

Cardioinhibitory carotid sinus hypersensitivity. Intracardiac recordings and clinical assessment

Cardioinhibitory Carotid Sinus Hypersensitivity

Cardioinhibitory carotid sinus hypersensitivity most frequently occurs in elderly men, predominantly during right carotid massage. Resting sinus bradycardia and aortic stenosis may be unusually prevalent in this subgroup of patients. Ventricular arrest occurs abruptly and may be preceded by brief prolongation of sinus cycle lengths and atrioventricular nodal conduction times. Gradual recovery of the sinoatrial rate follows resumption of sinus rhythm and is preceded by atrioventricular nodal recovery. His bundle electrocardiography is valuable in excluding other potential causes of syncope in patients with carotid sinus hypersensitivity. Despite a history of syncope, permanent pacing may not be indicated in the management of patients with carotid sinus hypersensitivity and otherwise normal electrophysiologic study.

A stand-still cerebral arteriogram secondary to heart block. A case report with discussion of its mechanism.

We have reported a most unusual serial carotid arteriogram in which there was nothing but the arterial phase on 11 films throughout an 8 sec exposure. No previous reports of this phenomenon could be found in the literature. We believe this stand-still arteriogram resulted from a momentary cardiac arrest or heart block which might have been induced by the injection of the contrast media in an arteriosclerotic individual possibly associated with cardioinhibitory carotid sinus reaction. The patients subclinical myocardial ischemia might have been a predisposing factor.

Treatment of Carotid Sinus Syncope with Demand Pacemaker

We report a patient with cardioinhibitory carotid sinus syndrome treated with a demand pacemaker. Implantation of a demand pacemaker is suggested as an alternative to the previously reported modes of surgical or irradiation therapy. We believe that the treatment with a demand pacemaker may be preferable because of its reliability.

The cardioinhibitory carotid sinus reflex: Its importance as a vagocardiosensitivity test ∗

An electrocardiographic study in patients showing a hyperactive cardioinhibitory carotid sinus reflex revealed various grades of sinoatrial slowing, sinoatrial arrest, A-V block, nodal escape, nodal rhythm, bifocal rhythm with interference dissociation, ectopic ventricular beats and marked changes in atrial and ventricular complexes. The hypersensitive areas are in the effector nerve endings of the heart which appear to be in greatest concentration in the S-A and A-V nodes. The most important factor causing vagal hyperactivity is a constitutional predisposition. Sensitization of the vagal endings in the heart is caused primarily by local myocardial ischemia due to coronary insufficiency. Vagomimetic drugs such as digitalis, acetyl-beta-methylcholine, morphine and neostigmine are other factors. The carotid sinus reflex should be considered an important test of vagal hypersensitivity and be used as a warning sign that the cardioinhibitory reflex may arise from other structures or organs of the body having pressorreceptor innervations, such as the biliary and gastrointestinal tracts and the tracheobronchial tree. Manipulations during operation in those areas may reflexly cause cardiac arrest or severe cardiac arrhythmias. This is particularly true if vagomimetic drugs are used prior to or during the operation and if the carotid sinus areas in the neck are carelessly compressed by the anesthetist.

THE CARDIOINHIBITORY CAROTID SINUS SYNDROME

Excerpt Of interest for years as a readily demonstrable etiologic factor in certain cases of syncopal or convulsive attacks, the cardioinhibitory carotid sinus syndrome has itself fallen under susp...

The Hyperactive Cardioinhibitory Carotid-Sinus Reflex as an Aid in the Diagnosis of Coronary Disease

Original Article from The New England Journal of Medicine — The Hyperactive Cardioinhibitory Carotid-Sinus Reflex as an Aid in the Diagnosis of Coronary Disease — Its Value Compared with That of the Electrocardiogram

Hyperactive cardioinhibitory carotid sinus reflex. A possible aid in the diagnosis of coronary disease: Sigler, Louis H.: Arch. Int. Med. 67: 177, 1941

Hyperactive cardioinhibitory carotid sinus reflex. A possible aid in the diagnosis of coronary disease: Sigler, Louis H.: Arch. Int. Med. 67: 177, 1941

HYPERACTIVE CARDIOINHIBITORY CAROTID SINUS REFLEX

Within the past few years, since the publication of the comprehensive experimental work on the carotid sinus reflex by Hering1and Heymans,2there has been some application of the knowledge regarding this reflex to clinical medicine. The most important contributions are those of Weiss and Baker,3Ferris, Capps and Weiss4and Weiss, Capps and Ferris.5They showed the relation of a hyperactive reflex to some of the unconscious and convulsive states in man. That unconsciousness and convulsions might be induced in some persons by pressing on a carotid artery at its bifurcation has been known for hundreds of years. Ask-Upmark6stated that the Assyrians used this method to dull pain during the rites of circumcision. The mechanism of its production, however, was not known until of late. Before the hyperactive cardioinhibitory carotid sinus reflex is considered, the normal carotid sinus mechanism with its various reflex responses