Carotid Sinus Syndrome: a review of the literature and our experience using carotid sinus denervation.

BACKGROUND: The Carotid Sinus Syndrome (CSS) is a rare condition causing spontaneous syncopal attacks or marked dizziness. METHODS: We studied 28 patients affected by CSS from January 1991 to October 1996. Eleven patients affected by cardioinhibitory type were treated by pace-maker (PM) implant. Seventeen patients had mixed type and all, but one who refused any treatment, entered this study. Carotid Sinus Denervation (CSD) was first performed in 2 of 10 patients who remained symptomatic after PM and in 6 patients as first choice therapy. RESULTS: At a mean follow-up of 30 months no patient submitted to CSD had recurrent syncopal attacks or dizziness. CONCLUSIONS: CSD is a safe and simple technique to abolish either the cardioinhibitory or the vasodepressor response in CSS.

[Incessant ectopic atrial tachycardia in pregnancy: radiofrequency catheter ablation in immediate postpartum with disappearance of tachycardia-related dilated cardiomyopathy]. / Tachicardia atriale ectopica incessante in corso di gravidanza: ablazione transcatetere mediante radiofrequenza nell'immediato post-partum con risoluzione del relativo quadro di cardiomiopatia dilatativa.

A 29-year-old woman presented with incessant atrial tachycardia and tachycardia-related cardiomyopathy during the last weeks of pregnancy. At 40 weeks of gestation a healthy infant was delivered by Cesarean section. Various medical treatments and two attempts of electrical cardioversion were ineffective in restoring sinus rhythm. Electrophysiologic study with endocardial activation mapping confirmed the diagnosis and thereafter radiofrequency transcatheter ablation of the ectopic focus was successfully carried out and sinus rhythm was restored. Serial 24-h Holter monitoring at 1, 3, and 6 months showed the persistence of sinus rhythm. Echocardiographic examinations demonstrated a very rapid recovery of both left ventricular diameters and ejection fraction to normal limits within two weeks after ablation. In this case-report the potential role of pregnancy and recent advances in the understanding and treatment of ectopic atrial tachycardia are summarized. Although endocardial mapping is difficult, radiofrequency catheter ablation appears to be the elective technique for the treatment of this particular arrhythmia, often refractory to antiarrhythmic drugs. Moreover, this case highlights that tachycardia-related cardiomyopathy should be seriously considered in any patient with apparently end-stage dilated cardiomyopathy and persistent tachycardia.