Glomectomy in carotid sinus syncope.

Carotid sinus hypersensitivity (CSH) is a common cause of syncope, and permanent pacemarker is unequivocally indicated in such patients. From 37 patients with spontaneous syncope, in 10 (mean age 60 years), CSH was confirmed by carotid sinus massage: cardioinhibitor CSH, 6 patients (asystole greater than 3 sec), cardioinhibitor and vasodepressor CSH, 4 patients (asystole greater than 3 sec, and decrease of systolic blood pressure by more than 30 mmHg). The sick sinus syndrome was excluded by electrophysiologic studies performed after autonomic blockade (atropine, 0.04 mg/kg, and propranolol 0.2 mg/kg): heart rate at rest (60.1 +/- 3.1 bpm); corrected intrinsic sinus node recovery time (29.5 +/- 92.8 ms); intrinsic sinoatrial conduction time (96.2 +/- 30.7 ms). No atrioventricular conduction disturbances occurred during atrial pacing up to 160 beats/min. Surgical removal of carotid glomus (glomectomy) was performed according to Nakayama's technique for bronchial asthma: right side 7 patients, left side 2 patients, both sides one patient. Postoperative follow-up from fourteen to forty-four months (mean 28 months), demonstrated excellent results. All but one patient remained asymptomatic. The heart rate at rest, autonomic chronotropy, and exercise tolerance improved significantly (p less than 0.001). Thus glomectomy appears to be the treatment of choice in selected patients with CSH and syncope.