Pattern of inhibition of parasympathetic activity in response to incremental bolus doses of atropine in carotid sinus hypersensitivity.

Patients with established reproducible cardioinhibitory carotid sinus hypersensitivity were studied to define the dose of atropine required to abolish the heart rate slowing in response to carotid sinus massage, the heart rate response to the Valsalva manoeuvre and salivary gland flow. Bolus doses of intravenous atropine were given to a cumulative dose of 700 mcg. Cardioinhibition was abolished in all patients with a total dose of 700 mcg. The heart rate ratio during the Valsalva manoeuvre did not vary significantly. The decline in salivary gland flow was evident earliest, at a dose of 75 mcg. In clinical studies, 700 mcg of atropine will abolish the diagnostic cardioinhibitory response to carotid sinus message in patients with the syndrome. This may not prevent syncope, as could occur in the key frequent vasodepressor form of carotid sinus hypersensitivity syndrome.