Brignole M, Menozzi C, Lolli G, Oddone D, Gianfranchi L, Bertulla A
Laboratory of Electrophysiology, Hospital of Lavagna, Italy.
Pacing Clin Electrophysiol. 1990 Dec;13(12 Pt 2):2071-5. doi: 10.1111/j.1540-8159.1990.tb06944.x.
The real incidence of pacemaker implants for carotid sinus syndrome (CSS) and the relation between CSS and sick sinus syndrome (SSS) is not precisely known. Patients who needed pacing therapy because of atrial bradyarrhythmias were investigated by means of carotid sinus massage, dynamic ECG, and invasive electrophysiological sinus node evaluation. Of 298 consecutive patients receiving a pacemaker implant, 36 (12%) had a severe cardioinhibitory carotid sinus reflex with reproducible spontaneous symptoms (CSS), 33 (11%) had sinus bradycardia less than 50 beats/min or an abnormal electrophysiological evaluation (SSS) and 24 (8%) had both (CSS + SSS). The annual incidence was 40, 37, and 26, respectively, implants per year/million of inhabitants (total incidence 325). Patients affected by CSS, if compared with those affected by SSS, showed: a higher prevalence of syncope (97% vs 42%); more syncopal episodes per patient (2.9 +/- 2 vs 1.8 +/- 0.9); a lower prevalence of associated cardiac diseases (53% vs 100%); cardiac enlargement (36% vs 88%); heart failure (6% vs 36%) and paroxysmal atrial fibrillation (0% vs 42%); and a more frequent indication for VVI pacing (75% vs 3%). In patients with CSS + SSS, intermediate characteristics were present. In conclusion, CSS is as frequent an indication to cardiac pacing as SSS; clinical differences justify a distinction between them, even if they are associated in 26% of cases.
因颈动脉窦综合征（CSS）而植入起搏器的实际发生率以及CSS与病态窦房结综合征（SSS）之间的关系尚不完全清楚。对因房性缓慢性心律失常而需要起搏治疗的患者进行了颈动脉窦按摩、动态心电图和有创电生理窦房结评估。在连续接受起搏器植入的298例患者中，36例（12%）有严重的心脏抑制性颈动脉窦反射且有可重复的自发症状（CSS），33例（11%）有窦性心动过缓低于50次/分钟或电生理评估异常（SSS），24例（8%）两者皆有（CSS + SSS）。年发生率分别为每年每百万居民40例、37例和26例植入（总发生率325例）。与SSS患者相比，CSS患者表现出：晕厥患病率更高（97%对42%）；每位患者晕厥发作次数更多（2.9±2对1.8±0.9）；相关心脏病患病率更低（53%对100%）；心脏扩大（36%对88%）；心力衰竭（6%对36%）和阵发性心房颤动（0%对42%）；以及VVI起搏的指征更频繁（75%对3%）。在CSS + SSS患者中，呈现出中间特征。总之，CSS作为心脏起搏的指征与SSS一样常见；临床差异证明即使它们在26%的病例中相关联，也有必要对它们进行区分。
