Kadermuneer P, Sandeep R, Haridasan Vellani, George Biju, Sajeev Chakanalil Govindan, Krishnan Mangalath Narayanan
Department of Cardiology, Government Medical College, Kozhikode, India.
Department of Cardiology, Rajagiri Hospital, Alwaye, India.
Indian Heart J. 2019 Jan-Feb;71(1):1-6. doi: 10.1016/j.ihj.2019.01.004. Epub 2019 Jan 30.
Carotid sinus syndrome accounts for one third of patients who presents with unexplained syncope. Prevalence of carotid sinus hypersensitivity (CSH) in Indians has not been studied till now.
To assess the prevalence and associations of CSH in symptomatic patients above 50 years and to study its prognostic significance pertaining to sudden cardiac death, syncope, recurrent pre syncope and falls on 1 year follow up.
Patients above 50 years who presented with unexplained syncope, recurrent syncope or falls were considered cases and those without these symptoms were considered as controls. All the patients underwent carotid sinus massage and their responses noted. All symptomatic patients were followed up and observed for events like sudden cardiac death, syncope, recurrent pre syncope and falls during 1 year follow up. Patients with recurrent syncope and predominant cardioinhibitory syncope were advised permanent pacemaker implantation.
A total of 252 patients were screened, 130 patients constituted cases and 49 patients constituted controls. CSH was demonstrable in 32% (n = 42) of cases as compared to 8% (n = 4) in controls (p < 0.001). Cardioinhibitory response was the predominant response (88%, n = 38) followed by mixed response (12%, n = 4). CSH was associated with advancing age, male gender (93%, n = 39, p < 0.001) and history of smoking (63%, n = 27, p = 0.009). Composite outcomes of sudden cardiac death, syncope, recurrent pre syncope and falls were significantly higher in patients with symptomatic CSH than in those without it (45%, n = 16 vs. 6.8%, n = 6; p < 0.001).
In conclusion, the prevalence of CSH in patients above 50 yrs with unexplained syncope was high in our population. Patients with CSH and baseline symptoms developed recurrent syncope during follow up. Carotid sinus massage should be a part of routine examination protocol for unexplained syncope.
在不明原因晕厥患者中，颈动脉窦综合征占三分之一。迄今为止，尚未对印度人颈动脉窦过敏（CSH）的患病率进行研究。
评估50岁以上有症状患者中CSH的患病率及相关性，并研究其与心源性猝死、晕厥、复发性晕厥前期及跌倒在1年随访中的预后意义。
将出现不明原因晕厥、复发性晕厥或跌倒的50岁以上患者视为病例，无这些症状的患者视为对照。所有患者均接受颈动脉窦按摩并记录其反应。对所有有症状的患者进行随访，观察心源性猝死、晕厥、复发性晕厥前期及跌倒等事件，为期1年。对复发性晕厥且主要为心脏抑制性晕厥的患者建议植入永久性起搏器。
共筛查252例患者，其中130例为病例，49例为对照。病例组中32%（n = 42）可检测到CSH，而对照组为8%（n = 4）（p < 0.001）。心脏抑制性反应是主要反应（88%，n = 38），其次是混合反应（12%，n = 4）。CSH与年龄增长、男性（93%，n = 39，p < 0.001）及吸烟史（63%，n = 27，p = 0.009）相关。有症状的CSH患者的心源性猝死、晕厥、复发性晕厥前期及跌倒的综合结局显著高于无CSH的患者（45%，n = 16 vs. 6.8%，n = 6；p < 0.001）。
总之，在我国50岁以上不明原因晕厥患者中，CSH的患病率较高。有CSH及基线症状的患者在随访期间出现复发性晕厥。颈动脉窦按摩应成为不明原因晕厥常规检查方案的一部分。
