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Implications for Diagnosis of Syncope and Falls

Simon R. J. Kerr, MB, MRCP; Mark S. Pearce, PhD; Carol Brayne, MD, FRCP; Richard J. Davis, MB, MRCGP; Rose Anne Kenny, MD, FRCP

Arch Intern Med. 2006;166:515-520.

Background  Carotid sinus hypersensitivity is the most commonly reported cause of falls and syncope in older persons. Recent guidelines recommend 5 to 10 seconds of carotid sinus massage in supine and upright positions with beat-to-beat monitoring. The aim of this study was to determine the prevalence of carotid sinus hypersensitivity in (1) an unselected community sample of older people and (2) a subsample with no history of syncope, dizziness, or falls using recently standardized diagnostic criteria.

Methods  One thousand individuals older than 65 years were randomly sampled from a single general practice register; 272 participants underwent supine and upright carotid sinus massage with continuous heart rate and phasic blood pressure monitoring. Carotid sinus hypersensitivity was defined as asystole of 3 seconds or greater and/or a drop in systolic blood pressure of 50 mm Hg or greater.

Results  Carotid sinus hypersensitivity was present in 107 individuals (39%); 24% had asystole of 3 seconds or greater during carotid sinus massage; and 16% had symptoms (including syncope) with carotid sinus hypersensitivity. Age (odds ratio, 1.05; 95% confidence interval, 1.00-1.09) and male sex (odds ratio, 1.71; 95% confidence intervals, 1.04-2.82) were the only predictors of carotid sinus hypersensitivity. In 80 previously asymptomatic individuals, carotid sinus hypersensitivity was present in 28 (35%) and accompanied by symptoms in 10. The 95th percentile for carotid sinus massage response was 7.3 seconds' asystole and a 77–mm Hg drop in systolic blood pressure.

Conclusions  Carotid sinus hypersensitivity is common in older persons, even those with no history of syncope, dizziness, or falls. The finding of a hypersensitive response should not necessarily preclude further investigation for other causes of syncope.

Author Affiliations: Institute for Ageing and Health (Drs Kerr and Kenny) and Paediatric and Lifecourse Research Group, School of Clinical Medical Sciences (Dr Pearce), University of Newcastle upon Tyne, Newcastle upon Tyne, England; Department of Public Health and Primary Care, University of Cambridge, Cambridge, England (Dr Brayne); Bridge End Surgery, Chester-le-Street, England (Dr Davis); and Neurosciences Institute, Trinity College, Dublin, Ireland (Dr Kenny).

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