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Carotid Sinus Massage in clinical practice : the Six-Step-Method

de Lange, Frederik J ; de Jong, Jelle Sy ; van Zanten, Steven ; Hofland, Willem Pme ; Tabak, Rick ; Cammenga, Marianne ; Francisco-Pascual, Jaume ; Russo, Vincenzo ; Fedorowski, Artur LU orcid and Deharo, Jean-Claude , et al. (2024) In Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 26(11).
Abstract

Carotid sinus massage (CSM) as integral part of cardiovascular autonomic testing, is indicated in all patients > 40 years with syncope of unknown origin and suspected reflex mechanism. However, large practice variation exists in performing CSM which inevitably affects the positivity rate of the test and may result in an inaccurate diagnosis in patients with unexplained syncope. Even though CSM was introduced into medical practice more than 100 years ago, the method of performing CSM is still largely operator- and centre-dependent, while in many places the test has been entirely abandoned. Here we describe a standardized protocol on how to perform CSM, which basic monitoring equipment is necessary and why CSM is a safe procedure to... (More)

Carotid sinus massage (CSM) as integral part of cardiovascular autonomic testing, is indicated in all patients > 40 years with syncope of unknown origin and suspected reflex mechanism. However, large practice variation exists in performing CSM which inevitably affects the positivity rate of the test and may result in an inaccurate diagnosis in patients with unexplained syncope. Even though CSM was introduced into medical practice more than 100 years ago, the method of performing CSM is still largely operator- and centre-dependent, while in many places the test has been entirely abandoned. Here we describe a standardized protocol on how to perform CSM, which basic monitoring equipment is necessary and why CSM is a safe procedure to perform. Our aim is to create an uniform approach to perform CSM. The new proposed algorithm, the Six Step Method includes: 1) Check history for exclusion CSM; 2) Turn head slightly contralaterally and posterior (see also explanatory video and poster provided as supplementary material; 3) Palpation to identify carotid sinus location; 4) Massage for 10 seconds; 5) Monitoring of blood pressure and heart rate to assess of the hemodynamic response type, and 6) Include time intervals between subsequent massages. CSM should be performed on both the left and right and in the supine and upright position. The recommended equipment to perform CSM consists of: 1) a tilt table in order to perform CSM in supine and standing position, 2) a continuous blood pressure monitor or cardiac monitor and 3) at least two persons.

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publishing date
type
Contribution to journal
publication status
published
subject
in
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
volume
26
issue
11
publisher
Oxford University Press
external identifiers
  • pmid:39397761
  • scopus:85208771687
ISSN
1532-2092
DOI
10.1093/europace/euae266
language
English
LU publication?
no
additional info
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
id
cc2efc72-42a7-4552-beda-dbfb9f98c983
date added to LUP
2024-10-23 11:52:43
date last changed
2025-07-27 11:35:56
@article{cc2efc72-42a7-4552-beda-dbfb9f98c983,
  abstract     = {{<p>Carotid sinus massage (CSM) as integral part of cardiovascular autonomic testing, is indicated in all patients &gt; 40 years with syncope of unknown origin and suspected reflex mechanism. However, large practice variation exists in performing CSM which inevitably affects the positivity rate of the test and may result in an inaccurate diagnosis in patients with unexplained syncope. Even though CSM was introduced into medical practice more than 100 years ago, the method of performing CSM is still largely operator- and centre-dependent, while in many places the test has been entirely abandoned. Here we describe a standardized protocol on how to perform CSM, which basic monitoring equipment is necessary and why CSM is a safe procedure to perform. Our aim is to create an uniform approach to perform CSM. The new proposed algorithm, the Six Step Method includes: 1) Check history for exclusion CSM; 2) Turn head slightly contralaterally and posterior (see also explanatory video and poster provided as supplementary material; 3) Palpation to identify carotid sinus location; 4) Massage for 10 seconds; 5) Monitoring of blood pressure and heart rate to assess of the hemodynamic response type, and 6) Include time intervals between subsequent massages. CSM should be performed on both the left and right and in the supine and upright position. The recommended equipment to perform CSM consists of: 1) a tilt table in order to perform CSM in supine and standing position, 2) a continuous blood pressure monitor or cardiac monitor and 3) at least two persons.</p>}},
  author       = {{de Lange, Frederik J and de Jong, Jelle Sy and van Zanten, Steven and Hofland, Willem Pme and Tabak, Rick and Cammenga, Marianne and Francisco-Pascual, Jaume and Russo, Vincenzo and Fedorowski, Artur and Deharo, Jean-Claude and Brignole, Michele}},
  issn         = {{1532-2092}},
  language     = {{eng}},
  month        = {{10}},
  number       = {{11}},
  publisher    = {{Oxford University Press}},
  series       = {{Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology}},
  title        = {{Carotid Sinus Massage in clinical practice : the Six-Step-Method}},
  url          = {{http://dx.doi.org/10.1093/europace/euae266}},
  doi          = {{10.1093/europace/euae266}},
  volume       = {{26}},
  year         = {{2024}},
}