Review
Carotid sinus massage. Its diagnostic and therapeutic value in arrhythmias

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Abstract

Carotid sinus massage is a simple bedside maneuver that helps to clarify the type and sometimes also the mechanism of different rhythm disturbances. The major indication for carotid sinus massage is the diagnosis of tachyarrhythmias In which the atrial activity is either absent or intermittently present. Carotid sinus massage Is also useful in some patients with normal heart rates; increased vagal tone may normalize a bundle branch block or localize the site of type I second-degree atrioventricular block and can be used for evaluation of the sensing function of permanent pacemakers. Carotid sinus massage is also an important diagnostic procedure In patients with suspected hypersensitivity of the carotid sinus. Massage of the carotid sinus is contraindicated in patients with diseased carotid arteries because of the risk of cerebrovascular accident. In rare instances, carotid sinus massage may initiate ventricular tachycardia.

References (69)

  • D Scherf et al.

    Appearance of ventricular ectopic rhythm during carotid sinus pressure

    Chest

    (1966)
  • S Alexander et al.

    Fatal ventricular fibrillation during carotid sinus stimulation

    Am J Cardiol

    (1966)
  • MV Cohen

    Ventricular fibrillation precipitated by carotid sinus pressure

  • JT Shepherd et al.

    The human cardiovascular system, facts and concepts

  • JC Longhurst

    Arterial baroreceptors in health and disease

    Cardiovasc Rev Rep

    (1982)
  • B Lown et al.

    The carotid sinus

  • SS Gooch et al.

    The relationship of carotid sinus stimulation to exercise testing

    J Electrocardiol

    (1983)
  • AE Cohn et al.

    The predominant influence of the left vagus nerve upon conduction between the auricles and ventricles in dog

    J Exp Med

    (1913)
  • J Rihl

    Klinishe beobachtungen uber die beziehung des vagus zeu extrasystoles

    Verh Dtsch Kongr Inn Med

    (1912)
  • HE Hering

    Die karotissinusreflexe auf herz und gefasse von normal physiologishen und klinishen standpunkt

    (1927)
  • S Wasserman

    Die angina pectoris ihre pathogenese und pathophysiologie

    Wien Klin Wochenschr

    (1928)
  • S Wassermann

    Zum mechanisms des akuten kardialen lungenodems: (Mit berucksichtigung eines electrokardiographierten und durch karotissinusdruck beendeten anfalls)

    Cardiologia

    (1939)
  • S Weiss et al.

    The carotid sinus reflex in health and disease: its role in the causation of fainting and convulsion

    Medicine (Baltimore)

    (1933)
  • MN Levy et al.

    The mechanisms of synchronization in isorhythmic A-V dissocaition. II. Clinical studies

    Circulation

    (1970)
  • MN Levy et al.

    A feedback mechanism responsible for fixed coupling in parasystole

    Circ Res

    (1972)
  • EA Jonas et al.

    Complete His-Purkinje block produced by carotid sinus massage

  • HJJ Wellens

    Electrical stimulation of the heart in the study and treatment of tachycardias

  • CH Heidoren et al.

    Effect of carotid sinus stimulation on the electrocardiogram of clinically normal individuals

    Circulation

    (1956)
  • PF Walter et al.

    Carotid sinus hypersensitivity and syncope

    Am J Cardiol

    (1978)
  • IM Mangardi et al.

    Bedside evaluation of atrioventricular block with narrow QRS complexes: usefulness of carotid sinus massage and atropine administration

    Am J Cardiol

    (1982)
  • JF Harrington

    Reversion of left bundle branch block to normal conduction by carotid sinus pressure

    N Engl J Med

    (1967)
  • SS Barold et al.

    Demand pacemakers: normal and abnormal mechanism of sensing

  • JD Fisher et al.

    Differential responses to carotid sinus massage in cardiac patients with and without syncope

    Pace

    (1981)
  • MH Nathanson

    Hyperactive cardioinhibitory sinus reflex

    Arch Intern Med

    (1946)
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