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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Amnesia for Loss of Consciousness in Carotid Sinus Syndrome

Implications for Presentation With Falls

Steve W. Parry, MBBS, PhD, MRCP^_*,_*, I. Nick Steen, PhD, Mary Baptist, RN^_* and Rose Anne Kenny, MD, FRCP, FRCP(I)^_*

^_* Falls and Syncope Service and Institute for Ageing and Health, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom

Manuscript received September 27, 2004; revised manuscript received February 10, 2005, accepted February 14, 2005.

^_* Reprint requests and correspondence: Dr. Steve W. Parry, Royal Victoria Infirmary, Cardiovascular Investigation Unit, Victoria Wing, Newcastle upon Tyne, Tyne and Wear NE1 4LP, United Kingdom. (Email: steve.parry{at}nuth.northy.nhs.uk).

OBJECTIVES: The goal of this study was to compare the clinical characteristics of patients with carotid sinus syndrome who presented with falls with those who presented with syncope.

BACKGROUND: Carotid sinus syndrome presents with both falls and syncope. The reasons for this differential presentation are unknown, but amnesia for loss of consciousness may be the underlying cause.

METHODS: Two groups of 34 consecutive patients with carotid sinus syndrome as the sole cause of falls and syncope were recruited. Cognitive function and clinical characteristics were compared between the two groups.

RESULTS: Syncopal subjects with carotid sinus syndrome were more likely to be older males (18 [53%] vs. 7 [21%] years; p = 0.006) with a longer duration of symptoms (27.9 vs. 13.3 months; p = 0.009) and more soft tissue injuries (19 [56%] vs. 9 [26%]; p = 0.03). Duration of asystole during carotid sinus massage was similar in both groups (5.1 vs. 5.4 s; p = 0.42), but witnessed amnesia for loss of consciousness was more frequent in fallers than those with syncope (21 [95%] vs. 4 [12%]; p < 0.001). Clinical characteristics and cognitive function were otherwise similar in both groups.

CONCLUSIONS: Patients with carotid sinus syndrome have similar rates of witnessed loss of consciousness during laboratory testing regardless of symptoms. However, those presenting with falls are far less likely to perceive any disturbance of consciousness than those with syncope, showing for the first time the manner in which such patients manifest symptoms. Cognitive impairment does not explain the amnesia for loss of consciousness seen in fallers with carotid sinus syndrome.

Abbreviations and Acronyms   CICSS = cardioinhibitory carotid sinus syndrome   CSM = carotid sinus massage   LOC = loss of consciousness   MMSE = mini-mental state examination   RR = relative risk

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