ABC | Volume 114, Nº2, February 2020

Original Article Long-Term Mortality in Cardioinhibitory Carotid Sinus Hypersensitivity Patient Cohort Gustavo de Castro Lacerda, 1, 2 A ndrea Rocha de Lorenzo, 1,2 Bernardo Rangel Tura, 1 Marcela Cedenilla dos Santos, 1 Artur Eduardo Cotrim Guimarães, 3 Renato Côrtes de Lacerda, 3 Roberto Coury Pedrosa 2 Instituto Nacional de Cardiologia, 1 Rio de Janeiro, RJ – Brazil Universidade Federal do Rio de Janeiro, 2 Rio de Janeiro, RJ – Brazil Hospital Federal de Bonsucesso, 3 Rio de Janeiro, RJ – Brazil Mailing Address: Gustavo de Castro Lacerda • Instituto Nacional de Cardiologia – Arritmia - Rua das Laranjeiras, 374. Postal Code 22240-008, Rio de Janeiro, RJ – Brazil E-mail: glacerda@cardiol.br Manuscript received January 04, 2019, revised manuscript March 18, 2019, accepted May 15, 2019 DOI: https://doi.org/10.36660/abc.20190008 Abstract Background: Cardioinhibitory carotid sinus hypersensitivity (CICSH) is defined as ventricular asystole ≥ 3 seconds in response to 5–10 seconds of carotid sinus massage (CSM). There is a common concern that a prolonged asystole episode could lead to death directly from bradycardia or as a consequence of serious trauma, brain injury or pause‑dependent ventricular arrhythmias. Objective: To describe total mortality, cardiovascular mortality and trauma-related mortality of a cohort of CICSH patients, and to compare those mortalities with those found in a non-CICSH patient cohort. Methods: In 2006, 502 patients ≥ 50 years of age were submitted to CSM. Fifty-two patients (10,4%) were identified with CICSH. Survival of this cohort was compared with that of another cohort of 408 non-CICSH patients using Kaplan-Meier curves. Cox regression was used to examine the relation between CICSH and mortality. The level of statistical significance was set at 0.05. Results: After a maximum follow-up of 11.6 years, 29 of the 52 CICSH patients (55.8%) were dead. Cardiovascular mortality, trauma‑related mortality and the total mortality rate of this population were not statistically different from that found in 408 patients without CICSH. (Total mortality of CICSH patients 55.8% vs. 49,3% of non-CICSH patients; p: 0.38). Conclusion: At the end of follow-up, the 52 CICSH patient cohort had total mortality, cardiovascular mortality and trauma-related mortality similar to that found in 408 patients without CICSH. (Arq Bras Cardiol. 2020; 114(2):245-253) Keywords: Carotid Sinus,Massage/mortality; Bradycardia; Syncope; Cardiac Pacing, Artificial. Introduction Carotid sinus hypersensitivity (CSH) is characterized by ventricular asystole ≥3 seconds, known as cardioinhibitory carotid sinus hypersensitivity (CICSH) or systolic blood pressure fall ≥50 mmHg (vasodepressor carotid sinus hypersensitivity) in response to 5–10 seconds of carotid sinus massage (CSM). 1,2 Epidemiologic studies of patients >40 years old have shown that this population have a high prevalence of CSH (10–50%). 3,4 This prevalence is even higher among men and in patients with atherosclerosis. 3,4 Carotid sinus hypersensitivity can be present with or without spontaneous symptoms. 1 On the other hand, diagnosis of carotid sinus syncope (CSS) requires the presence of vasodepressor or CICSH and syncope. 1,5 Carotid sinus syncope is considered one of the most frequent causes of syncope in the elderly. 6 Treatment is generally indicated for CSS patients to reduce recurrence of symptoms. 1,2 The concern that a prolonged asystole episode could lead to serious trauma, brain injury, pause-dependent ventricular arrhythmias and death is also used to justify treatment. 5,7 The main objective of present study is to describe the long-term mortality rate of a cohort of CICSH patients. Secondly, it compares total mortality, cardiovascular mortality, mortality due to ischemic heart disease and trauma-related mortality of this patient cohort with that of a cohort of patients without CICSH. Methods In 2006, in the first phase of the present study, 502 patients were randomly selected among 1,686 outpatients ≥50 years of age referred to electrocardiography in a public general hospital in Rio de Janeiro, Brazil. 8 These 502 patients were submitted to CSM, 52 (10,4%) were identified with CICSH (ventricular asystole ≥3) and, in 450, cardioinhibitory reflex was absent. In all cases, CSMwas performed in the supine position, initially on the right side, then on the left side for 10 seconds by a single investigator.More patient selection details andmore information about CSM can be found in a previous article. 8 245