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Carotid Sinus Hypersensitivity Treatment & Management

  • Author: Mevan N Wijetunga, MD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
 
Updated: Dec 18, 2014
 

Medical Care

Management of carotid sinus hypersensitivity (CSH) is based on the frequency, severity, and consequences of each patient's symptoms.

Most patients can be treated with education, lifestyle changes, expectancy, and routine follow-up.

A few individuals who have incapacitating and recurrent symptoms may need the following treatments:

Pharmacotherapy has been used to treat recurrent, symptomatic conditions. However, no single agent has been proven to provide long-term effectiveness in large-scale, randomized, controlled trials.

Permanent pacemaker implantation is generally considered an effective treatment for cardioinhibitory CSH and mixed forms of CSH.

Current American College of Cardiology/American Heart Association/Heart Rhythm Society clinical practice guidelines consider permanent pacing therapy to be a class I indication (ie, general agreement exists that the therapy is effective and useful) in patients with recurrent syncope caused by carotid sinus stimulation in the absence of any drug that depresses the sinus node or atrioventricular conduction. Permanent pacing is considered a class IIa indication in patients with recurrent syncope without clear, provocative events and with a hypersensitive cardioinhibitory response. Permanent pacing is discouraged in patients with a hypersensitive cardioinhibitory response to carotid sinus stimulation in the absence of symptoms.[20, 21, 22, 23]

The consensus is that dual chamber pacing (DDD, DVI, DDI) is optimal in the patients. However, VVI mode is also effective in preventing recurrent syncope in some patients. AAI and VDD modes are considered inappropriate.

Cardiac pacing has little or no effect on the vasodepressor type of CSH and may not reduce the frequency of falls in patients with CSH. Permanent pacing may diminish but not entirely eliminate the symptoms in CSH.

Volume maintenance can control the vasodepressor form of CSH, preventing syncopal episodes by maintaining adequate central volume. An individual without another cardiovascular disease should increase salt intake and drink more fluids containing electrolytes.

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Surgical Care

Surgical denervation and radiological denervation of the carotid sinus nerve were techniques used previously, but they have been largely abandoned because of high complication rates.

Surgery remains an option for a patient with a neck tumor that is compressing the carotid sinus.

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Consultations

Consult an electrophysiologist or cardiologist to rule out cardiac arrhythmia and evaluate the patient for pacemaker implantation.

Obtain a surgical consultation and evaluation if the patient has a neck tumor that is compressing the carotid sinus.

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Activity

No general activity restrictions are necessary.

Patients should be aware of prodromal symptoms of presyncope or syncope. In such circumstances, immediately assuming supine posture is recommended to prevent syncope and/or falls.

Precipitating events, such as wearing tight neck collars or sudden rotating neck movements, should be avoided.

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Contributor Information and Disclosures
Author

Mevan N Wijetunga, MD, FACC, FHRS Cardiac Electrophysiologist, CentraCare Heart & Vascular Center

Mevan N Wijetunga, MD, FACC, FHRS is a member of the following medical societies: American College of Cardiology

Disclosure: Nothing to disclose.

Coauthor(s)

Irwin J Schatz, MD † Former Professor, Department of Internal Medicine, University of Hawaii, John A Burns School of Medicine

Irwin J Schatz, MD is a member of the following medical societies: Alpha Omega Alpha, American Autonomic Society, American College of Cardiology, American College of Physicians, American Federation for Medical Research, American Heart Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steven J Compton, MD, FACC, FACP, FHRS Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals

Steven J Compton, MD, FACC, FACP, FHRS is a member of the following medical societies: American College of Physicians, American Heart Association, American Medical Association, Heart Rhythm Society, Alaska State Medical Association, American College of Cardiology

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD Professor of Medicine, Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine; Cardiologist/Electrophysiologist, University of Maryland Medical System and VA Maryland Health Care System

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association, Heart Rhythm Society

Disclosure: Nothing to disclose.

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