Carotid sinus massage, eyeball compression, and head-up tilt test in patients with syncope of uncertain origin and in healthy control subjects.

To verify the role of abnormal neural mechanisms in unexplained syncopes, we evaluated the results of carotid sinus massage (CSM), eyeball compression (EBC), and head-up tilt test (HUT) in the basal state (B) and during isoproterenol infusion (ISO) in: (1) 100 consecutive patients affected by syncope which, despite careful cardiovascular and neurologic examination, was of uncertain origin (age 60 +/- 18 years; 54 men) and (2) 25 healthy subjects matched 4:1 with the patients of the previous group. All the patients underwent CSM and EBC in the supine and standing position for 10 seconds and HUT at 60 degrees for 60 minutes; if HUT-B was negative (68 cases), it was repeated during ISO (1 to 5 micrograms/min) infusion. In the patients with uncertain syncope, spontaneous symptoms were fully reproduced in 49%, 16%, 32%, and 16% of cases respectively by means of CSM, EBC, HUT, and HUT-ISO; overall positivity for at least one test was observed in 79% of cases. The results of CSM, EBC, or HUT-ISO were linked to age, sex, and underlying heart disease. In the healthy subjects, syncope was induced by CSM, EBC, HUT, and HUT-ISO in one case each; overall positivity was 16%. In conclusion, neural reflex induction tests reproduced spontaneous symptoms in most patients affected by uncertain syncope, while they evoked normal responses in most healthy subjects. Therefore on the basis of results of induction tests, the diagnosis of neurally mediated syncope can be ascribed to most patients affected by syncope of uncertain origin.