Bedside Carotid Sinus Massage for Syncope Evaluation With Bifascicular Block and First-Degree Atrioventricular Block

Mashood B Badshah; Muhammad Hamza Saad Shaukat; Azar Birlas; Scott Pham

doi:10.7759/cureus.33925

Bedside Carotid Sinus Massage for Syncope Evaluation With Bifascicular Block and First-Degree Atrioventricular Block

Cureus. 2023 Jan 18;15(1):e33925. doi: 10.7759/cureus.33925. eCollection 2023 Jan.

Authors

Mashood B Badshah¹, Muhammad Hamza Saad Shaukat², Azar Birlas³, Scott Pham²

Affiliations

¹ Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA.
² Cardiology, University of South Dakota Sanford School of Medicine, Sioux Falls, USA.
³ Internal Medicine, Rehman Medical College, Peshawar, PAK.

Abstract

Symptomatic bifascicular block (BFB) with a reversible high-grade atrioventricular block (AVB) is an overlooked cause of syncope with differing diagnostic and therapeutic approaches. We present a case of a 79-year-old gentleman with multiple episodes of cardiac syncope. Initial electrocardiogram revealed a left bundle branch block and first-degree AVB worsened by bedside carotid sinus massage (CSM) obviating the need for electrophysiologic (EP) studies or continuous electrocardiographic monitoring for further evaluation. This case highlights the importance of CSM as a useful clinical tool in addition to EP studies and internal loop recorder (ILR) placement for assessment and appropriateness of permanent pacemaker (PPM) implantation. It also sheds light on the differing management protocols between EP studies and ILR evaluation versus empiric PPM implantation for patients with cardiac syncope secondary to BFB and AVB.

Keywords: atrioventricular block; bifascicular block; cardiac syncope; carotid sinus massage; permanent pacemaker.

Publication types

Case Reports