The role of cardiac pacing therapy in the management of carotid sinus syndrome

Abstract

Introduction. Carotid sinus syndrome is characterized by a hypersensitive carotid sinus and syncope. Although we have clear guidelines for the diagnosis and treatment of carotid sinus syndrome, the efficacy of pacing therapy with this indication has not been the subject of many studies. Objective. This study aimed to assess the efficacy and safety of pacing therapy in the treatment of patients with carotid sinus syndrome and to determine the factors contributing to symptoms recurrence after pacemaker implantation. Methods. This study was retrospective and included 32 patients in whom a pacemaker was implanted due to carotid sinus syndrome at the Pacemaker Center, Clinical Center of Serbia, between April 2005 and April 2012. Carotid sinus massage and head-up tilt test (HUTT) were performed to select patients with cardioinhibitory and mixed type carotid sinus syndrome, who were enrolled to the study. Results. The mean age of patients was 65.6±11.5 years and 20 (62.5%) were men. The mean follow-up period was 4.3±1.9 years. HUTT was performed in 3 (9.4%) patients. Twenty-seven (84.4%) patients presented with cardioinhibitory and 5 (15.6%) with mixed type of carotid sinus syndrome. After pacemaker implantation, 22 (68.7%) patients had no further symptoms, 8 (25.0%) had syncope and 2 (6.3%) presyncope. The mixed type of the disease (HR 3.1; 95% CI 1.4-5.1; p=0.021) and implantation of pacemaker in VVI mode (HR 1.8; 95%CI 1.1-3.2; p=0.034) were independent predictors of symptoms recurrence. There were 3 (9.4%) perioperative surgical complications. Conclusion. Pacemaker therapy is an effective and safe treatment for patients with carotid sinus syndrome. As predictors of symptoms persistence after pacemaker implantation in our population, we identified the implantation of pacemaker in VVI mode and the mixed type of carotid sinus syndrome.

Keywords

• syncope
• carotid sinus syndrome
• pacemaker therapy