SHM Converge Scientific Abstract ePoster Gallery-Carotid Sinus Hypersensitivity: A Novel Minimally-Invasive Treatment

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This case describes a 62-year-old man with type 2 diabetes and a prior cerebellar stroke from vertebral artery dissection who developed positional lightheadedness when turning his head while supine. He was not taking medications commonly associated with orthostatic symptoms and had no clear triggers such as dehydration or alcohol use.<br /><br />Autonomic testing showed findings consistent with cardioinhibitory carotid sinus hypersensitivity (CSH). Before treatment, right carotid sinus massage caused marked sinus arrest with a junctional escape rhythm and profound bradycardia; left-sided massage caused a less severe response. Orthostatic vitals also showed a large immediate blood pressure drop on standing. Physical exam and cardiac evaluation were otherwise unremarkable.<br /><br />The patient underwent minimally invasive cardioneuroablation (CNA), a procedure aimed at reducing excessive vagal input to the heart. After CNA, he reported immediate improvement with minimal dizziness and no syncope. An implantable loop recorder showed no sinus pauses or ventricular block over 6 months. Although he was later hospitalized with recurrent symptoms, repeat autonomic testing demonstrated sustained resolution of the cardioinhibitory component of CSH.<br /><br />The report highlights that reflex-mediated syncope, including vasovagal, situational, and carotid sinus hypersensitivity syncope, can significantly impair quality of life. While pacemaker implantation is the standard treatment for severe cardioinhibitory CSH, CNA may offer a promising alternative in selected patients. The authors note that this is one of only nine reported cases of CNA for cardioinhibitory CSH and one of only two with implantable loop recorder data, supporting further investigation of this novel approach.

Asset Subtitle

Alyssa Kahl

Meta Tag

Author List Addison A. Taylor, Alyssa Kahl, Jeffrey Bates, Paul Schurmann

Category Clinical Vignettes

Concept Cardioinhibitory Carotid Sinus Hypersensitivity

Concept Carotid Sinus Massage

Concept Pacemaker Therapy

Concept Cardioneuroablation

Concept Autonomic Testing

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Alyssa Kahl

Track Adult

Keywords

carotid sinus hypersensitivity

cardioinhibitory syncope

cardioneuroablation

sinus arrest

bradycardia

autonomic testing

vasovagal syncope

implantable loop recorder

orthostatic hypotension

reflex-mediated syncope

Cardioinhibitory Carotid Sinus Hypersensitivity

Carotid Sinus Massage

Pacemaker Therapy

Cardioneuroablation

Autonomic Testing