Management

The management of CSH centres on trigger avoidance and the prevention or control of symptomatic episodes. This approach typically combines lifestyle modifications, pharmacologic therapy, and, in selected cases, device-based interventions such as pacemaker implantation. Treatment is tailored according to CSH subtype, whether vasodepressor, cardioinhibitory, or mixed, and symptom severity.

Patients with a clinical diagnosis of carotid sinus syndrome and two or more episodes of syncope should be given a dual chamber pacemaker (1) as this will abolish syncope in 90% of patients.

Reference

1. Lopes R et al. The role of pacemaker in hypersensitive carotid sinus syndrome. Europace. 2011 Apr;13(4):572-5

Reference:

• EBM 1999; 4 (6): 170.
• Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. May 27 2008;51(21):e1-62