INCIDENCE OF COMPLICATIONS AFTER CAROTID-SINUS MASSAGE IN OLDER PATIENTS WITH SYNCOPE

OBJECTIVE: To review the incidence of neurological complications occur ring after carotid sinus massage performed for diagnostic purposes. DE SIGN: Case review and comparison with previously published work. SETTI NG: Syncope Clinic, Royal Victoria Infirmary, Newcastle-upon-Tyne, and Chelsea and Westminster Hospital, London. PARTICIPANTS: Patients unde rgoing investigation of dizziness, syncope, or unexplained falls. METH ODS: Carotid sinus massage performed for 5 seconds in both supine and erect postures, both before and after atropine. Contraindications to c arotid sinus massage were the presence of carotid bruits, recent myoca rdial or cerebral ischemia, or previous ventricular tachyarrhythmias. RESULTS: Two cases of neurological complications were reported from a total of 500 patients (2000 massage episodes) investigated in one cent er,giving an incidence of 0.1%. Combining this data with another cente r performing investigations in a similar fashion, seven neurological c omplications arose from a total of 5000 massage episodes, an incidence of 0.14%. Reported complications were pyramidal signs in five cases a nd visual held defects in two. Pyramidal weakness persisted in one cas e with a pre-existing stroke on the same side, and a visual field loss was permanent in one. CONCLUSIONS: Neurological complications followi ng carotid sinus massage for diagnosis of the carotid sinus syndrome a re uncommon and usually transient. Contraindications to carotid sinus massage should be respected and the standardized technique used.