Carotid sinus hypersensivity syndrome also known as Bishop's syndrome is an uncommon cause of syncope. Carotid sinus hypersensitivity may be an important cause of syncope even in patients thought to have other causes of syncope. We report a patient who presented with syncope and had supraventricular tachycardia documented on Holter monitor. Patient subsequently underwent diagnostic EP study and was inducible for two different types of tachycardias that obviously were not the cause of syncope. He finally had long hemodynamically significant pauses on carotid sinus massage. Case History A 77-year-old white male who had witnessed syncope at home after he had carried groceries and while turning his head. No premonitory symptoms were observed and no seizures and bowel or bladder disturbances were noted. He had extensive workup that included EEG (Electroencephalography), CT (computed Tomography) scan of head, echocardiography and cardiac stress test. All of these diagnostic studies performed were found to be unremarkable. He was discharged and given a holter monitor that revealed long ““RP”” tachycardia suggestive of atrial tachycardia. Considering that this may have caused his syncope he was taken for an EP study. He was inducible for atrial tachycardia (Fig 1) that was septal in origin and also had typical AV node reentry (Fig 2). Both of these arrhythmias were successfully ablated using non-contact mapping system however during neither of these tachycardias patient was hemodynamically unstable. Patient remained symptomatic after ablation therapy and finally had carotid sinus massage done. He had hemodynamically significant 4.6 second long pause (fig 3), thereby accounting for his syncope after head turning. Patient received a dual chamber pacer and has been asymptomatic.
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