Age and Ageing Advance Access originally published online on September 7, 2009
Age and Ageing 2009 38(6):680-686; doi:10.1093/ageing/afp160
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Results of carotid sinus massage in a tertiary referral unit—is carotid sinus syndrome still relevant?
1 Institute for Ageing and Health, Wolfson Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
2 Falls and Syncope Service, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
3 Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK
4 Institute of Health and Society, 21, Claremont Place, Newcastle University, Newcastle upon Tyne NE2 4AA, UK
Address correspondence to: S. W. Parry. Tel: (+44) 191 2825237; Fax: (+44) 191 2825338. E-mail: swparry{at}hotmail.com
Background: carotid sinus hypersensitivity (CSH) is associated with syncope, drop attacks and unexplained falls in older people. However, a recent study has also reported a prevalence of 35% in asymptomatic community-dwelling older people.
Objective: we conducted a retrospective observational study to investigate the haemodynamic and symptom responses of a large cohort of patients undergoing carotid sinus massage (CSM).
Methods: the electronically stored haemodynamic data of 302 consecutive patients, aged 71 ± 11 years, investigated with CSM for unexplained falls and syncope was analysed. Bilateral sequential CSM was performed in the supine and upright positions with continuous electrocardiogram (ECG) and non-invasive beat-to-beat blood pressure monitoring (TaskforceTM, CN Systems, Austria). CSH (CSH) was defined by maximal R–R interval 
3 s (cardioinhibitory) and/or a systolic blood pressure drop of 50 mmHg (vasodepressor).
Results: a total of 74/302 (25%) subjects had CSH, 37 (50%) of which were cardioinhibitory (CI) and 37 (50%) were vasodepressor (VD) subtypes. Subjects with positive CSM were significantly older (75.2 vs 70.2 years, P < 0.001), and more likely to be male (32% vs 19%, P < 0.01). CSH was diagnosed with right-sided CSM alone in 45 (61%) subjects and erect CSM only in 36 (49%) subjects. Symptom reproduction was more likely with the CI than the VD subtypes (82% vs 28%; P < 0.001).
Conclusion: CSH was diagnosed in 25% of patients investigated with CSM at our specialist unit, lower than the prevalence of 39% reported for community-dwelling older individuals. This discrepancy may be explained by selection bias and demographic differences, but raises the possibility of CSH being an age-related epiphenomenon rather than a causal mechanism for syncope, drop attacks and unexplained falls. Our observations have important implications for clinical practice and the development of future research strategies.
Keywords: carotid sinus hypersensitivity, syncope, loss of consciousness, non-accidental falls, elderly
Received 15 November 2008; accepted in revised form 4 June 2009.