Performing Carotid Sinus Massage

  • Roberto Maggi
  • Michele Brignole


Carotid sinus syndrome is a frequent cause of syncope, especially in the elderly. The initial evaluation for this condition consists of a patient history, physical examination, standard electrocardiogram (ECG) and systemic blood pressure measurement in the supine and upright positions. If the origin of syncope remains uncertain, carotid sinus massage (CSM) together with the tilt test becomes the method of choice to unmask neuromediated syncopes.


Upright Position Carotid Sinus Cardiac Pace Sick Sinus Syndrome Unexplained Syncope 
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  1. 1.
    Mc Intosh SJ, Lawson J, Kenny RA (1993) Clinical characteristics of vasodepressor, cardioinhibitory and mixed carotid sinus syndrome in the elderly. Am J Med 95:203–208CrossRefGoogle Scholar
  2. 2.
    Graux P, Mekerke W, Lemaire N et al (1989) Le syndrome du sinus carotidien. Apport de la monitorisation de la pression arterielle a l’exploration electrophysiologique endocavitaire. Arch Mal Coeur 82:193–199PubMedGoogle Scholar
  3. 3.
    Huang SKS, Ezri MD, Honser RG, Denes P (1988) Carotid sinus hypersensitivity in patients with unexplained syncope: clinical, electrophysiologic, and long-term follow-up observation. Am Heart J 116:989–996PubMedCrossRefGoogle Scholar
  4. 4.
    Volkmann H, Schnerch B, Kuhnert H (1990) Diagnostic value of carotid sinus hypersensitivity. Pacing Clin Electrophysiol 13:2065–2070PubMedGoogle Scholar
  5. 5.
    Parry SW, Richardson D, O’Shea D et al (2000) Diagnosis of carotid sinus hypersensitivity in older adults: carotid sinus massage in the upright position is essential. Heart 83:22–23PubMedCrossRefGoogle Scholar
  6. 6.
    Brignole M, Sartore B, Prato R (1983) Role of body position during carotid sinus stimulation test in the diagnosis of cardioinhibitory carotid sinus syndrome. G Ital Cardiol 14:69–72Google Scholar
  7. 7.
    Thomas JE (1969) Hyperactive carotid sinus reflex and carotid sinus syncope. Mayo Clin Proc 44:127–139PubMedGoogle Scholar
  8. 8.
    Brignole M, Menozzi C, Lolli G et al (1992) Long-term outcome of paced and non paced patients with severe carotid sinus syndrome. Am J Cardiol 69:1039–1043PubMedCrossRefGoogle Scholar
  9. 9.
    Brignole M, Menozzi C (1992) Carotid sinus syndrome: diagnosis, natural history and treatment. Eur J Cardiac Pacing Electrophysiol 4:247–254Google Scholar
  10. 10.
    Brignole M, Menozzi C, Gianfranchi L et al (1991) Carotid sinus massage, eyeball compression and head-up tilt test in patients with syncope of uncertain origin and in healthy control subjects. Am Heart J 122:1644–1651PubMedCrossRefGoogle Scholar
  11. 11.
    Brignole M, Menozzi C, Gianfranchi L et al (1991) Neurally mediated syncope detected by carotid sinus massage and head-up tilt test in sick sinus syndrome. Am J Cardiol 68:1032–1036PubMedCrossRefGoogle Scholar
  12. 12.
    Puggioni E, Guiducci V, Brignole M et al (2002) Results and complications of the carotid sinus massage performed according to the “Methods of Symptoms”. Am J Cardiol 89:599–601PubMedCrossRefGoogle Scholar
  13. 13.
    Gaggioli G, Brignole M, Menozzi C et al (1995) Reappraisal of the vasodepressor reflex in carotid sinus syndrome. Am J Cardiol 75:518–521PubMedCrossRefGoogle Scholar
  14. 14.
    Brignole M, Menozzi C, Lolli G et al (1991) Validation of a method for choice of pacing mode in carotid sinus syndrome with or without sinus bradycardia. Pacing Clin Electrophysiol 14:196–203PubMedCrossRefGoogle Scholar
  15. 15.
    Munro N, McIntosh S, Lawson J et al (1994) The incidence of complications after carotid sinus massage in older patients with syncope. J Am Geriatr Soc 42:1248–1251PubMedGoogle Scholar
  16. 16.
    Davies AG, Kenny RA (1998) Neurological complications following carotid sinus massage. Am J Cardiol 81:1256–1257PubMedCrossRefGoogle Scholar
  17. 17.
    Franke H (1963) Uber das karotissinus-syndrome und den sogennanten hyperactiven karotissinus reflex. Fridrich-Kave Schattaueur, StuttgartGoogle Scholar
  18. 18.
    Brignole M, Alboni P, Benditt DG et al (2004) Guidelines on management (diagnosis and treatment) of syncope — Update 2004. Europace 6:467–537PubMedCrossRefGoogle Scholar
  19. 19.
    Kapoor W, Snustad D, Peterson J et al (1986) Syncope in the elderly. Am J Med 80:419–427PubMedCrossRefGoogle Scholar
  20. 20.
    Mathias CJ, Deguchi K, Schatz I (2001) Observation on recurrent syncope and presyncope in 641 patients. Lancet 357:348–353PubMedCrossRefGoogle Scholar
  21. 21.
    Ammirati F, Colivicchi F, Santini M (2000) Diagnosing syncope in clinical practice. Eur Heart J 21:935–940PubMedCrossRefGoogle Scholar
  22. 22.
    Morley CA, Perrins EJ, Chan SL, Sutton R (1983) Long-term comparison of DVI and VVI pacing in carotid sinus syndrome. In: Steinbach K (ed) Proceedings of the VII World Symposium on Cardiac Pacing. Steinkopff Verlag, Darmstadt, pp 929–935Google Scholar
  23. 23.
    Stryjer D, Friedensohn A, Schlesinger Z (1986) Ventricular pacing as the preferable mode for lomg-term pacing in patients with carotid sinus syncope of the cardioinhibitory type. Pacing Clin Electrophysiol 9:705–709PubMedCrossRefGoogle Scholar
  24. 24.
    Blanc JJ, Boshat J, Penther Ph (1984) Hypersensibilité sino-carotidienne. Evolution à moyen terme en fonction du traitement et de ses symptomes. Arch Mal Coeur 77:330–336PubMedGoogle Scholar
  25. 25.
    Maggi R, Menozzi C, Brignole M et al (2007) Cardioinhibitory carotid sinus hypersensitivity predicts an asystolic mechanism of spontaneous neurally-mediated syncope. Europace (in press)Google Scholar
  26. 26.
    Brignole M, Moya A, Menozzi C et al (2005) Proposed electrocardiographic classification of spontaneous syncope documented by an implantable loop recorder. Europace 7:14–18PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Roberto Maggi
    • 1
  • Michele Brignole
    • 1
  1. 1.Arrhythmologic Centre, Department of CardiologyOspedali del TigullioLavagna (GE)Italy

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