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William M. Landau, MD
Washington University School of Medicine St Louis, Mo

JAMA. 1996;276(17):1383.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—In regard to the evaluation of a patient who had fallen without fainting, Dr Lipsitz¹ broadly recommends, "Carotid sinus massage should be performed on patients with unexplained falls, syncope, or drop attacks." He assures that "complications from carotid sinus massage... are very rare," citing Munro et al,² who described a cohort in which 0.44% of 1600 patients had neurological complications, none trivial. Munro et al² (and Lipsitz) arbitrarily spared from this risk those patients with "carotid bruits, recent myocardial or cerebral ischemia, or previous ventricular tachyarrhythmias." They did not define the concurrent benefits for the regiment of patients who did not escape the test.

My own review of the carotid sinus syndrome literature³ cited many more reports of patients who suffered stroke, death by stroke, ventricular dysrhythmia, and death by ventricular fibrillation or asystole. One group of authors⁴ stated that one third . . . [Full Text PDF of this Article]

Footnotes
Edited by Margaret A. Winker, MD, Senior Editor, and Phil B. Fontanarosa, MD, Senior Editor.

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