cardiac arrest following carotid sinus massage
TRANSCRIPT
EP IMAGES: FROM CELL TO BEDSIDESection Editor: David S. Rosenbaum, M.D.
Cardiac Arrest Following Carotid Sinus MassageDANIELA TONTSCH, M.D., PETER ALTER, M.D., and WOLFRAM GRIMM, M.D.
From the Division of Cardiology, Department of Medicine, Hospital of the Philipps-University of Marburg, Marburg, Germany
Right-sided carotid sinus massage was performed in a78-year-old woman who had a ventricular rate of 150 beats/min due to suspected atrial � utter and 2:1 AV conduction inorder to slow the ventricular response. Carotid sinus mas-sage (Fig., arrow) initially unmasked atrial � utter with anatrial rate of 300 beats/min. Despite discontinuation ofcarotid massage after approximately 2 seconds, atrial � utterwith complete heart block persisted, followed by completeatrial and ventricular asystole and loss of consciousness, asshown in the continuous rhythm strip (paper speed 50mm/sec). After administration of atropine and initiation ofexternal cardiac massage, a supraventricular rhythm re-sumed after 55 seconds of ventricular asystole, followed bysinus rhythm with 1:1 AV conduction. The patient recov-ered completely without any neurologic sequelae. Uponrestoration of sinus rhythm, continuous ECG monitoringand 12-lead ECG obtained 1 hour after carotid sinus mas-sage showed persistent sinus rhythm without � rst- or sec-ond-degree AV block and without bundle branch block. Ofnote, this patient was not treated with any drugs known tointerfere with sinus node function or AV conduction at thetime of carotid sinus massage. The patient’s history did notreveal any episodes of dizziness or syncope suggestive ofsick sinus syndrome or carotid sinus syndrome. Subsequentnoninvasive cardiovascular work-up, which included echo-cardiography and exercise stress test, did not reveal anyevidence of structural heart disease. Although repeatedHolter monitoring did not show any spontaneous episodesof bradycardia or AV block, the patient received a perma-nent pacemaker before hospital discharge.
This case report is a reminder that, in rare instances,
carotid sinus massage can lead to cardiac arrest. Thus,carotid sinus massage should be performed exclusively un-der ECG monitor control by physicians with appropriatetraining in advanced cardiac life support.
J Cardiovasc Electrophysiol, Vol. 12, p. 1331, November 2001.
Address for correspondence: Wolfram Grimm, M.D., Department of Car-diology, Hospital of the Philipps-University Marburg, Baldingerstrabe,35033 Marburg, Germany. Fax: 49-6421-286-8954; E-mail:[email protected]
1331Reprinted with permission fromJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Volume 12, No. 11, November 2001
Copyright ©2001 by Futura Publishing Company, Inc., Armonk, NY 10504-0418