ELECTROPHYSIOLOGY
Carotid sinus syndrome: a modifiable risk factor for nonaccidental falls in older adults (SAFE PACE)
Rose Anne M. Kenny, MD, FRCP*,*,
David A. Richardson, MRCP*,
Nick Steen, PhD ,
Rodney S. Bexton, DM, FRCP ,
Fiona E. Shaw, MRCP* and
John Bond, BA
* Cardiovascular Investigation Unit, Royal Victoria Infirmary/MRC Development Centre for Clinical Brain Ageing, Newcastle General Hospital, Newcastle Upon Tyne, United Kingdom
Centre for Health Services Research, University of Newcastle Upon Tyne, Newcastle Upon Tyne, United Kingdom
Regional Cardiothoracic Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
Manuscript received March 30, 2001;
revised manuscript received June 20, 2001,
accepted August 1, 2001.
* Reprint requests and correspondence: Professor Rose Anne Kenny, Cardiovascular Investigation Unit and Institute for the Health of the Elderly, Victoria Wing, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne NE1 4LP, UK.
r.a.kenny{at}ncl.ac.uk
OBJECTIVES
The aim of the study was to determine whether cardiac pacing reduces falls in older adults with cardioinhibitory carotid sinus hypersensitivity (CSH).
BACKGROUND
Cardioinhibitory carotid sinus syndrome causes syncope, and symptoms respond to cardiac pacing. There is circumstantial evidence for an association between falls and the syndrome.
METHODS
A randomized controlled trial was done of consecutive older patients (>50 years) attending an accident and emergency facility because of a non-accidental fall. Patients were randomized to dual-chamber pacemaker implant (paced patients) or standard treatment (controls). The primary outcome was the number of falls during one year of follow-up.
RESULTS
One hundred seventy-five eligible patients (mean age 73 ± 10 years; 60% women) were randomized to the trial: pacemaker 87; controls 88. Falls (without loss of consciousness) were reduced by two-thirds: controls reported 669 falls (mean 9.3; range 0 to 89), and paced patients 216 falls (mean 4.1; range 0 to 29). Thus, paced patients were significantly less likely to fall (odds ratio 0.42; 95% confidence interval: 0.23, 0.75) than were controls. Syncopal events were also reduced during the follow-up period, but there were much fewer syncopal events than falls—28 episodes in paced patients and 47 in controls. Injurious events were reduced by 70% (202 in controls compared to 61 in paced patients).
CONCLUSIONS
There is a strong association between non-accidental falls and cardioinhibitory CSH. These patients would not usually be referred for cardiovascular assessment. Carotid sinus hypersensitivity should be considered in all older adults who have non-accidental falls.
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Abbreviations and Acronyms
| | CSH | = carotid sinus hypersensitivity | | CSM | = carotid sinus massage | | MMSE | = mini-mental state examination | | SAFE PACE | = Syncope And Falls in the Elderly—Pacing And Carotid sinus Evaluation |
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Eur. Heart J.,
November 1, 2009;
30(21):
2631 - 2671.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. P. Tan, J. L. Newton, P. Reeve, A. Murray, T. J. Chadwick, and S. W. Parry
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38(6):
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[PDF]
|
|
|
|
|
|
|
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IBMS BoneKEy,
October 1, 2009;
6(10):
368 - 384.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M Solbiati, L Angaroni, G Costantino, and N Montano
Pacing in elderly recurrent fallers with carotid sinus hypersensitivity
Heart,
September 1, 2009;
95(17):
1455 - 1455.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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The authors' reply
Heart,
September 1, 2009;
95(17):
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|
|
|
|
|
|
|
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Syncope: therapeutic approaches.
J. Am. Coll. Cardiol.,
May 12, 2009;
53(19):
1741 - 1751.
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[Full Text]
[PDF]
|
|
|
|
|
|
|
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The Newcastle protocols 2008: an update on head-up tilt table testing and the management of vasovagal syncope and related disorders
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March 1, 2009;
95(5):
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[PDF]
|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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March 1, 2009;
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|
|
|
|
|
|
|
K. Kaszala, J. F. Huizar, and K. A. Ellenbogen
Contemporary Pacemakers: What the Primary Care Physician Needs to Know
Mayo Clin. Proc.,
October 1, 2008;
83(10):
1170 - 1186.
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|
|
|
|
|
|
|
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J. Am. Coll. Cardiol.,
May 27, 2008;
51(21):
e1 - e62.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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May 27, 2008;
117(21):
e350 - e408.
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|
|
|
|
|
|
|
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Physical injuries caused by a transient loss of consciousness: main clinical characteristics of patients and diagnostic contribution of carotid sinus massage
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March 1, 2008;
29(5):
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[PDF]
|
|
|
|
|
|
|
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Syncope and trauma. Are syncope-related traumatic injuries the key to find the specific cause of the symptom?
Eur. Heart J.,
March 1, 2008;
29(5):
576 - 578.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. J. Campbell and M. C. Robertson
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November 1, 2007;
36(6):
656 - 662.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Bordier, M. Colsy, F. Robert, and G. Bourenane
Prevalence of positive carotid sinus massage and related risk of syncope in patients with Alzheimer's disease
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September 1, 2007;
9(9):
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|
|
|
|
|
|
|
D. G. Benditt and on behalf of the Ad Hoc Syncope Consortium
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December 1, 2006;
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|
|
|
|
|
|
|
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June 1, 2006;
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|
|
|
|
|
|
|
N. L. Coplan
Carotid sinus hypersensitivity and syncope: cause/effect or true/true/unrelated.
Arch Intern Med,
March 13, 2006;
166(5):
491 - 492.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls.
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March 13, 2006;
166(5):
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[Full Text]
[PDF]
|
|
|
|
|
|
|
S. A. Strickberger, D. W. Benson, I. Biaggioni, D. J. Callans, M. I. Cohen, K. A. Ellenbogen, A. E. Epstein, P. Friedman, J. Goldberger, P. A. Heidenreich, et al.
AHA/ACCF Scientific Statement on the Evaluation of Syncope: From the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation In Collaboration With the Heart Rhythm Society
J. Am. Coll. Cardiol.,
January 17, 2006;
47(2):
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[Full Text]
[PDF]
|
|
|
|
|
|
|
S. A. Strickberger, D. W. Benson, I. Biaggioni, D. J. Callans, M. I. Cohen, K. A. Ellenbogen, A. E. Epstein, P. Friedman, J. Goldberger, P. A. Heidenreich, et al.
AHA/ACCF Scientific Statement on the Evaluation of Syncope: From the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation: In Collaboration With the Heart Rhythm Society: Endorsed by the American Autonomic Society
Circulation,
January 17, 2006;
113(2):
316 - 327.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. W. Parry, I. N. Steen, M. Baptist, and R. A. Kenny
Amnesia for Loss of Consciousness in Carotid Sinus Syndrome: Implications for Presentation With Falls
J. Am. Coll. Cardiol.,
June 7, 2005;
45(11):
1840 - 1843.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R A Kenny, F E Shaw, J T O'Brien, P H Scheltens, R Kalaria, and C Ballard
Carotid sinus syndrome is common in dementia with Lewy bodies and correlates with deep white matter lesions
J. Neurol. Neurosurg. Psychiatry,
July 1, 2004;
75(7):
966 - 971.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Ermis and D. G. Benditt
Carotid sinus massage during evaluation for transient loss of consciousness: just a positive test?
Europace,
January 1, 2004;
6(4):
292 - 295.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. M. Singh, M. I. Zia, and R. A. Fowler
Cat naps: an elderly woman with recurrent syncope
Can. Med. Assoc. J.,
October 28, 2003;
169(9):
940 - 940.
[Full Text]
|
|
|
|
|
|
|
N. Goldschlager, A. E. Epstein, B. P. Grubb, B. Olshansky, E. Prystowsky, W. C. Roberts, M. M. Scheinman, and for the Practice Guidelines Subcommittee, North Am
Etiologic Considerations in the Patient With Syncope and an Apparently Normal Heart
Arch Intern Med,
January 27, 2003;
163(2):
151 - 162.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. J. Campbell
Preventing fractures by preventing falls in older women
Can. Med. Assoc. J.,
October 29, 2002;
167(9):
1005 - 1006.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Homoud
Cardiac pacing reduced non-accidental falls in older adults with cardioinhibitory carotid sinus hypersensitivity
Evid. Based Med.,
July 1, 2002;
7(4):
115 - 115.
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. M. Kusumoto and N. Goldschlager
Device Therapy for Cardiac Arrhythmias
JAMA,
April 10, 2002;
287(14):
1848 - 1852.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. E. Mitchell, D. A. Richardson, A. J. Davies, R. S. Bexton, and R. A. Kenny
Prevalence of hypotensive disorders in older patients with a pacemaker in situ who attend the Accident and Emergency Department because of falls or syncope
Europace,
January 1, 2002;
4(2):
143 - 147.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. A. Richardson, R. Bexton, F. E. Shaw, N. Steen, J. Bond, and R. A. Kenny
How reproducible is the cardioinhibitory response to carotid sinus massage in fallers?
Europace,
January 1, 2002;
4(4):
361 - 364.
[Abstract]
[PDF]
|
|
|
|
