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Arq Bras Cardiol 2021 Apr;116(4):814-835

Serviço de Eletrofisiologia do Vitória Apart Hospital, Vitória, ES - Brasil.

Dysautonomia covers a range of clinical conditions with different characteristics and prognoses. They are classified as Reflex Syndromes, Postural Orthostatic Tachycardia Syndrome (POTS), Chronic Fatigue Syndrome, Neurogenic Orthostatic Hypotension (nOH) and Carotid Sinus Hypersensitivity Syndrome. Reflex (vasovagal) syndromes will not be discussed in this article. Read More

Iran J Otorhinolaryngol 2021 Jan;33(114):61-64

Otorhinolaryngology Section, Department of Biomedicine, Neurosciences and Advanced Diagnostic - University of Palermo, Palermo, Italy.

Introduction: Carotid sinus syndrome (CSS) is a hypersensitivity of the carotid sinus manifested by atrioventricular sinus bradycardia or decreased arterial pressure of at least 50 mmHg. Triggering factors can be neck movements, shaving of the beard or too-tight collars. CSS can be rarely caused by the presence of malignant or benign masses in the head and neck area. Read More

Surg J (N Y) 2020 Oct 14;6(4):e192-e194. Epub 2020 Dec 14.

Department of B' Pediatric Surgery, General Children's Hospital of Athens "Panagiotis and Aglaia Kyriakou," Attikis, Greece.

Postoperative complications after total thyroidectomy with extensive neck dissection in thyroid malignancies are well documented in the current literature. However, sinus bradycardia as a postthyroidectomy complication is a rare phenomenon and, to the best of our knowledge, few studies have identified it as a perioperative condition. In our study, we report a case of 9-year-old boy with papillary thyroid carcinoma, who underwent total thyroidectomy and bilateral neck dissection. Read More

Pacing Clin Electrophysiol 2020 10 22;43(10):1190-1193. Epub 2020 Sep 22.

Department of Cardiology, Arrhythmology Centre and Syncope Unit, Ospedali del Tigullio, Lavagna, Italy.

Aims: The reproducibility of carotid sinus massage (CSM) is debated. The aim of this study was to assess the reproducibility according to the methodology and diagnostic criteria defined by the guidelines on syncope of the European Society of Cardiology.

Method: Among 2800 patients with syncope who underwent CSM in the years 2005-2019, 109 patients (62 males; mean age 76 ± 10 years) had performed a second CSM after a median of 28 months. Read More

Arq Bras Cardiol 2020 02;114(2):254-255

Hospital das Clínicas Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, SP - Brazil.

Arq Bras Cardiol 2020 02;114(2):245-253

Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brazil2.

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. Read More

Ann Noninvasive Electrocardiol 2020 07 29;25(4):e12744. Epub 2020 Jan 29.

Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY, USA.

Background: Implantation of the subcutaneous implantable cardioverter-defibrillator (S-ICD) is spreading and has been shown to be safe and effective; however, it does not provide brady-pacing. Currently, data on the need for brady-pacing and cardiac resynchronization therapy (CRT) implantation in patients with ICD indication are limited.

Methods: The Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II enrolled post-MI patients with reduced ejection fraction (EF ≤ 35%), randomized to either an implantable cardioverter-defibrillator (ICD) or conventional medical therapy. Read More

J Geriatr Phys Ther 2020 Oct/Dec;43(4):E53-E57

Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania.

Background/purpose: The carotid bifurcation (CB) is the location of the carotid sinus and the baroreceptors and is also a major site for atherosclerotic plaque formation. Health care providers have therefore been cautioned to avoid the CB during carotid pulse palpation (CPP) to prevent triggering the baroreflex, occluding an artery, or propagating a thrombus. Potential risks of adverse events during CPP may be greater for older adults due to age-related vascular changes and increased risk of baroreceptor hypersensitivity. Read More

Brain Pathol 2020 01 16;30(1):191-202. Epub 2019 Aug 16.

Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom.

We performed a clinicopathological study to assess the burden of small vessel disease (SVD) type of pathological changes in elderly demented subjects, who had clinical evidence of autonomic dysfunction, either carotid sinus hypersensitivity or orthostatic hypotension or both or had exhibited unexpected repeated falls. Clinical and neuropathological diagnoses in 112 demented subjects comprised dementia with Lewy bodies (DLB), Parkinson's disease with dementia (PDD), Alzheimer's disease (AD), Mixed dementia (mostly AD-DLB) and vascular dementia (VaD). Of these, 12 DLB subjects had no recorded unexpected falls in life and therefore no evidence of concomitant autonomic dysfunction. Read More

Indian Heart J 2019 Jan - Feb;71(1):1-6. Epub 2019 Jan 30.

Department of Cardiology, Government Medical College, Kozhikode, India.

Background: Carotid sinus syndrome accounts for one third of patients who presents with unexplained syncope. Prevalence of carotid sinus hypersensitivity (CSH) in Indians has not been studied till now.

Objectives: To assess the prevalence and associations of CSH in symptomatic patients above 50 years and to study its prognostic significance pertaining to sudden cardiac death, syncope, recurrent pre syncope and falls on 1 year follow up. Read More

J Nutr Health Aging 2019 ;23(4):330-337

Nathalie van der Velde, PhD, Amsterdam University Medical Center, Department of Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam 1105AZ, the Netherlands, Tel. nr: +31 20-5665991, e-mail:

Objective: Cardiovascular abnormalities are consistently associated with fall risk in older people. However, little research has been done to assess the effect of cardiovascular interventions on fall risk. The aim of this scoping review is to explore the current literature on the effectiveness of cardiovascular evaluations and interventions in reducing fall risk in older people. Read More

Med J Aust 2019 04 4;210(6):257-257.e1. Epub 2019 Mar 4.

Calvary Public Hospital, Canberra, ACT.

Medicine (Baltimore) 2018 Sep;97(37):e12335

Department of Neurology Department of Cardiology Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, P.R. China Duke-Nus Graduate Medical School, Singapore, Singapore.

Rationale: Carotid sinus hypersensitivity (CSH) is traditionally classified into 3 subgroups: cardioinhibitory, vasodepressor, and mixed subtypes. However, the underlying mechanism of CSH in head and neck cancer is controversial. Several pathological mechanisms of CSH have been proposed: atherosclerotic noncompliance, sternocleidomastoid proprioceptive denervation, and generalized autonomic dysfunction. Read More

Arq Bras Cardiol 2018 Jul;111(1):84-91

Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil.

Background: Carotid sinus hypersensitivity (CSH) is a frequent finding in the evaluation of syncope. However, its significance in the clinical setting is still dubious. A new criterion was proposed by Solari et al. Read More

Herzschrittmacherther Elektrophysiol 2018 Jun 29;29(2):166-170. Epub 2018 May 29.

Service de Cardiologie, CHU La Timone, 13005, Marseille, France.

Adenosine is a ubiquitous substance that is released under several physiological and pathological conditions and has cardiovascular effects including cardioinhibition and vasodilation. It has been shown to be an important modulator implicated in several forms of syncope. In patients with chronic low plasma levels of adenosine, a transient release of endogenous adenosine can be sufficient to block conduction in the atrioventricular node and induce prolonged asystole; conversely, when plasma adenosine levels are chronically high, adenosine release is responsible for vasodepression. Read More

Front Pharmacol 2017 12;8:913. Epub 2017 Dec 12.

Centro de Estudos de Doenças Crónicas, NOVA Medical School - Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal.

It is known that adenosine and adenosine-5'-triphosphate (ATP) are excitatory mediators involved in carotid body (CB) hypoxic signaling. The CBs are peripheral chemoreceptors classically defined by O, CO, and pH sensors. When hypoxia activates the CB, it induces the release of neurotransmitters from chemoreceptor cells leading to an increase in the action potentials frequency at the carotid sinus nerve (CSN). Read More

Physiol Rep 2017 Oct 16;5(19). Epub 2017 Oct 16.

Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada

The arterial baroreflex is crucial for short-term blood pressure control - abnormal baroreflex function predisposes to syncope and falling. Hypersensitive responses to carotid baroreflex stimulation using carotid sinus massage (CSM) are common in older adults and may be associated with syncope. The pathophysiology of this hypersensitivity is unknown, but chronic denervation of the sternocleidomastoid muscles is common in elderly patients with carotid sinus hypersensitivity (CSH), and is proposed to interfere with normal integration of afferent firing from the carotid baroreceptors with proprioceptive feedback from the sternocleidomastoids, producing large responses to CSM. Read More

Postepy Kardiol Interwencyjnej 2017 25;13(2):184-185. Epub 2017 May 25.

Cardiology Unit, Policlinico Casilino, Rome, Italy.

Ned Tijdschr Geneeskd 2017 ;161:D1312

AMC, afd. Cardiologie, Amsterdam.

Carotid sinus massage for diagnosis and termination of supraventricular tachycardia (SVT) is still a widely used vagal manoeuvre in the A&E department. However, itsefficacy is limited (termination of the SVT in approximately 20%) and carotid sinus massage may be complicated by (potentially devastating) neurologic complications in 0.2-1% of the patients. Read More

Ned Tijdschr Geneeskd 2017 ;161:D826

VU medisch centrum, afd. Neurologie, Amsterdam.

Background: Carotid sinus massage is a widely used method for diagnosis and treatment of supraventricular tachycardia and carotid sinus hypersensitivity. Complications, mostly neurological, can occur but are rare. Carotid stenosis is a risk factor for complications. Read More

J Electrocardiol 2017 Jul - Aug;50(4):523-525. Epub 2017 Mar 14.

Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Swallow induced syncope is a rare clinical condition which is thought to result from an abnormal vagal reflex leading to bradycardia and cerebral hypoperfusion. It mostly occurs in patients with organic or functional disorders of the esophagus, and often requires permanent pacemaker implantation, along with treatment of the underlying esophageal pathology. In the following case, we report of a 71-year-old male with achalasia post per oral endoscopic myectomy, who presented with syncope and documented AV-block while eating solid food. Read More

Heart Rhythm 2017 08 9;14(8):e255-e269. Epub 2017 Mar 9.

Objectives: To determine, using systematic review of the biomedical literature, whether pacing reduces risk of recurrent syncope and relevant clinical outcomes among adult patients with reflex-mediated syncope.

Methods: MEDLINE (through PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (through October 7, 2015) were searched for randomized trials and observational studies examining pacing and syncope, and the bibliographies of known systematic reviews were also examined. Studies were rejected for poor-quality study methods and for the lack of the population, intervention, comparator, or outcome(s) of interest. Read More

J Am Coll Cardiol 2017 Aug 9;70(5):664-679. Epub 2017 Mar 9.

Objectives: To determine, using systematic review of the biomedical literature, whether pacing reduces risk of recurrent syncope and relevant clinical outcomes among adult patients with reflex-mediated syncope.

Methods: MEDLINE (through PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (through October 7, 2015) were searched for randomized trials and observational studies examining pacing and syncope, and the bibliographies of known systematic reviews were also examined. Studies were rejected for poor-quality study methods and for the lack of the population, intervention, comparator, or outcome(s) of interest. Read More

Circulation 2017 Aug 9;136(5):e123-e135. Epub 2017 Mar 9.

Objectives: To determine, using systematic review of the biomedical literature, whether pacing reduces risk of recurrent syncope and relevant clinical outcomes among adult patients with reflex-mediated syncope.

Methods: MEDLINE (through PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (through October 7, 2015) were searched for randomized trials and observational studies examining pacing and syncope, and the bibliographies of known systematic reviews were also examined. Studies were rejected for poor-quality study methods and for the lack of the population, intervention, comparator, or outcome(s) of interest. Read More

BMC Anesthesiol 2016 10 6;16(1):85. Epub 2016 Oct 6.

Department of General Surgery, University Hospital of Crete, Heraklion, Crete, Greece.

Background: We present a case of a patient with multinodular goiter disease who suffered asystole during head hyperextension for surgical positioning on the operational table.

Case Presentation: Manipulation of carotid sinus may trigger bradycardia or even asystole even in patients without prior history of carotid sinus hypersensitivity. The time proximity between patient positioning and asystole, the late responsiveness to atropine, the immediate increase of heart rate after head elevation and the lack of any other trigger factor or prior history support the hypothesis of carotid sinus syndrome. Read More

Rom J Intern Med 2016 Sep;54(3):173-178

Background: Syncope is a commonly encountered problem in an emergency hospital. Global cerebral hypoperfusion is the final pathway common to all presentations of syncope, but this symptom presentation has a broad differential diagnosis. It is important to identify patients for whom syncope is a symptom of a potentially life-threatening condition. Read More

Yale J Biol Med 2016 03 24;89(1):59-71. Epub 2016 Mar 24.

Professor of Medical Gerontology, Mercer's Institute for Successful Ageing, St. James' Hospital, Hospital 4 Top Floor, Dublin 8, Ireland.

Neurocardiovascular instability (NCVI) refers to abnormal neural control of the cardiovascular system affecting blood pressure and heart rate behavior. Autonomic dysfunction and impaired cerebral autoregulation in aging contribute to this phenomenon characterized by hypotension and bradyarrhythmia. Ultimately, this increases the risk of falls and syncope in older people. Read More

Neurol Clin 2016 Aug;34(3):525-45

Department of Neurology, Columbia University College of Physicians and Surgeons, Neurological Institute of New York, 710 West 168th Street, New York, NY 10032, USA. Electronic address:

Syncope, or the sudden loss of consciousness, is a common presenting symptom for evaluation by neurologists. It is not a unique diagnosis but rather a common manifestation of disorders with diverse mechanisms. Loss of consciousness is typically preceded by a prodrome of symptoms and sometimes there is a clear trigger. Read More