![]() ![]() The relationship between CSS and spontaneous, otherwise unexplained syncope had been supposed in an older study (10) using a pacemaker designed to detect asystolic episodes. It is well known that abnormal responses are frequently observed in subjects without syncope, for example, in 17–20% of asymptomatic patients affected by various types of cardiovascular diseases (8) and in 38% of asymptomatic patients with severe narrowing of the carotid arteries (9). Since a positive response to CSM can be frequently found even in many patients without syncope, its diagnostic value is questionned because of low specificity. Major trauma (defined as bone segments fracture, intracranial haemorrhage, internal organ lesions requiring urgent, specific treatment retrograde amnesia or focal neurologic defect) are more frequent in CCS that to the other patients with syncope afferring to the emergency department (24% versus 4.8% ) (7) Is a positive CSM diagnostic the cause of syncope? The rate of positive responses to CSM increases with age, ranging from 4% in patients 80 yrs (2).Īmong patients with CSS, two thirds are males, 45% have a dominant cardioinhibitory form, 40% a mixed form and 15% a dominant vasodepressor form in the cardioinhibitory and mixed forms the mean ventricular pause is >6 s duration (2).This percentage rises up to 60% in patients with syncope and sick sinus syndrome (6) CSS was found in 26% of 1719 consecutive patients performing appropriately CSM for syncope of uncertain origin (one out of four test performed) (2). ![]()
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