Complications of carotid sinus massage - A prospective series of older patients

Background: there is a causal association between carotid sinus hypersensit ivity, falls and syncope in elderly subjects. Neurological complications du ring carotid sinus massage have been reported in case studies and two retro spective series. Our aim was prospectively to ascertain the incidence of co mplications occurring after carotid sinus massage performed for diagnostic purposes in a consecutive series of patients. Methods: 1000 consecutive subjects aged 50 years or over who attended the a ccident and emergency department with syncope or 'unexplained' falls had ca rotid sinus massage. Carotid sinus massage was performed for 5 s on the rig ht and then left sides both supine and upright (70 degrees head-up tilt) wi th continuous heart rate and phasic blood pressure recording. Contraindicat ions to carotid sinus massage were the presence of a carotid bruit, recent history of stroke or myocardial infarction or previous ventricular tachyarr hythmia. Results: complications occurred in nine patients immediately after cessatio n of carotid sinus massage. Eight had transient neurological complications possibly attributable to carotid sinus massage: visual disturbance, 'pins a cid needles' and sensation of finger numbness in two cases each, leg weakne ss in one and sensation of 'being drunk' in one. All transient complication s resolved within 24 h. In one patient mild weakness of the right hand pers isted. Conclusions: no subjects had cardiac complications and 1% had possible neur ological symptoms, which resolved in most cases. Persistent neurological co mplications are uncommon, occurring in 1:1000 patients (0.1%) or 1 : 3805 e pisodes of carotid sinus massage (0.03%).