The main causes of neurally mediated syncope (NMS) are carotid sinus syndrome (CSS) and vasovagal syncope. Long before, carotid sinus denervation was performed for different diseases, but for the first time we consider glomectomy (G) as a surgical treatment for NMS and related arrhythmias, alone or associated with cardiac pacing (PM).
We used Nakayama's technique for bronchial asthma, modified by us: removal of hypersensitive carotid glomus and presinusal lymphadenectomy. Forty five patients (pts) with recurrent NMS (cardioinhibitory 14 pts, mixed 31 pts) were included: 41 males, 4 females, aged 23-84 (mean 60 yrs). The diagnosis was documented clinically by carotid sinus massage, ECG-Holter, electrophysiologic studies, head-up tilt test. Malignant orthostatic syndrome was present in 4 pts, tussive syncope in one, sick sinus syndrome (SSS) in 6 pts, atrial fibrillation and flutter in 6 pts, AV block in 2 pts. Thirty four pts underwent G alone; 6 pts-G and PM; 5 pts-PM alone, 3 pts-G plus carotid endarterectomy.
of G were excellent. All pts became free of syncope (max. follow-up 10 yrs). In addition, stable sinus rhythm was obtained in two pts (one with severe atrial fibrillation, another with persistent atrial fibrillation). In pts with SSS, A-V block or atrial fibrillation with bradycardia, PM was inserted (DDDR or VVIR). However, in pts with vasodepressor component of NMS, symptoms persist until G was performed.
We conclude that our data support the efficiency of G in pts with NMS (either cardioinhibitor or vasodepressor), as well as in related arrhythmias. PM is indicated in pts with associated diseases: intrinsic SSS, AV block, atrial fibrillation with bradycardia.