Carotid Sinus Hypersensitivity Medication
- Author: Mevan N Wijetunga, MD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD more...
Although a variety of pharmacological agents has been used empirically to treat recurrent, symptomatic CSH, no single agent has been unequivocally proven to provide long-term effectiveness in large-scale, randomized controlled trials. Some observers have successfully used the serotonin reuptake inhibitors sertraline and fluoxetine in patients who were unresponsive to dual-chamber pacing.
A randomized, controlled pilot study showed that treatment with midodrine, an alpha-1 agonist, could significantly decrease the rate of symptoms and the degree of hypotension in the vasodepressor form of CSH. Treatment with midodrine was also associated with an elevation of a mean 24-hour ambulatory blood pressure level. Midodrine induces arterial and venous capacitance constriction and has minimal cerebral and cardiac effects. It is indicated for the treatment of symptomatic orthostatic hypotension.
Fludrocortisone is another agent that can be used in this setting.
The US Food and Drug Administration has not yet approved these agents for the management of CSH.
Seifer C. Carotid sinus syndrome. Cardiol Clin. 2013 Feb. 31(1):111-21. [Medline].
Parry SW, Steen N, Bexton RS, Tynan M, Kenny RA. Pacing in elderly recurrent fallers with carotid sinus hypersensitivity: a randomised, double-blind, placebo controlled crossover trial. Heart. 2009 May. 95(5):405-9. [Medline].
Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2009 Apr 15. CD007146. [Medline].
Smebye KL, Granum S, Wyller TB, Mellingsæter M. Medical findings in an interdisciplinary geriatric outpatient clinic specialising in falls. Tidsskr Nor Laegeforen. 2014 Apr 8. 134(7):705-9. [Medline].
Ziegelstein RC. Near-syncope after exercise. JAMA. 2004 Sep 8. 292(10):1221-6. [Medline].
Tan MP, Newton JL, Chadwick TJ, Parry SW. The relationship between carotid sinus hypersensitivity, orthostatic hypotension, and vasovagal syncope: a case-control study. Europace. 2008 Dec. 10(12):1400-5. [Medline].
Krediet CT, Jardine DL, Wieling W. Dissection of carotid sinus hypersensitivity: the timing of vagal and vasodepressor effects and the effect of body position. Clin Sci (Lond). 2011 Nov. 121(9):389-96. [Medline].
Tan MP, Kenny RA, Chadwick TJ, Kerr SR, Parry SW. Carotid sinus hypersensitivity: disease state or clinical sign of ageing? Insights from a controlled study of autonomic function in symptomatic and asymptomatic subjects. Europace. 2010 Nov. 12(11):1630-6. [Medline].
Miller VM, Kenny RA, Slade JY, Oakley AE, Kalaria RN. Medullary autonomic pathology in carotid sinus hypersensitivity. Neuropathol Appl Neurobiol. 2008 Aug. 34(4):403-11. [Medline].
Tan MP, Chadwick TJ, Kerr SR, Parry SW. Symptomatic presentation of carotid sinus hypersensitivity is associated with impaired cerebral autoregulation. J Am Heart Assoc. 2014 Jun 19. 3(3):e000514. [Medline].
Lacerda Gde C, Pedrosa RC, Lacerda RC, et al. Cardioinhibitory carotid sinus hypersensitivity: prevalence and predictors in 502 outpatients. Arq Bras Cardiol. 2008 Mar. 90(3):148-55. [Medline].
Wieling W, Krediet CT, Solari D, de Lange FJ, van Dijk N, Thijs RD, et al. At the heart of the arterial baroreflex: a physiological basis for a new classification of carotid sinus hypersensitivity. J Intern Med. 2013 Apr. 273(4):345-58. [Medline].
Kuo FY, Hsiao HC, Chiou CW, Liu CP. Recurrent syncope due to carotid sinus hypersensitivity and sick sinus syndrome. J Chin Med Assoc. 2008 Oct. 71(10):532-5. [Medline].
McIntosh SJ, Lawson J, Kenny RA. Clinical characteristics of vasodepressor, cardioinhibitory, and mixed carotid sinus syndrome in the elderly. Am J Med. 1993 Aug. 95(2):203-8. [Medline].
Ballard C, Shaw F, McKeith I, Kenny R. High prevalence of neurovascular instability in neurodegenerative dementias. Neurology. 1998 Dec. 51(6):1760-2. [Medline].
Kenny RA, Shaw FE, O'Brien JT, Scheltens PH, Kalaria R, Ballard C. Carotid sinus syndrome is common in dementia with Lewy bodies and correlates with deep white matter lesions. J Neurol Neurosurg Psychiatry. 2004 Jul. 75(7):966-71. [Medline].
Kenny RA, O'Shea D, Parry SW. The Newcastle protocols for head-up tilt table testing in the diagnosis of vasovagal syncope, carotid sinus hypersensitivity, and related disorders. Heart. 2000 May. 83(5):564-9. [Medline].
Morillo CA, Camacho ME, Wood MA, et al. Diagnostic utility of mechanical, pharmacological and orthostatic stimulation of the carotid sinus in patients with unexplained syncope. J Am Coll Cardiol. 1999 Nov 1. 34(5):1587-94. [Medline].
Krediet CT, Parry SW, Jardine DL, Benditt DG, Brignole M, Wieling W. The history of diagnosing carotid sinus hypersensitivity: why are the current criteria too sensitive?. Europace. 2011 Jan. 13(1):14-22. [Medline].
Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008 May 27. 51(21):e1-62. [Medline].
Kenny RA, Richardson DA, Steen N, et al. Carotid sinus syndrome: a modifiable risk factor for nonaccidental falls in older adults (SAFE PACE). J Am Coll Cardiol. 2001 Nov 1. 38(5):1491-6. [Medline].
Ryan DJ, Nick S, Colette SM, Roseanne K. Carotid sinus syndrome, should we pace? A multicentre, randomised control trial (Safepace 2). Heart. 2010 Mar. 96(5):347-51. [Medline].
Brignole M, Menozzi C, Lolli G, et al. Long-term outcome of paced and nonpaced patients with severe carotid sinus syndrome. Am J Cardiol. 1992 Apr 15. 69(12):1039-43. [Medline].
Moore A, Watts M, Sheehy T, et al. Treatment of vasodepressor carotid sinus syndrome with midodrine: a randomized, controlled pilot study. J Am Geriatr Soc. 2005 Jan. 53(1):114-8. [Medline].
Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J. 2009 Nov. 30(21):2631-71. [Medline]. [Full Text].