Indications, contraindications, and step-by-step methodology for performing carotid sinus massage in patients presenting with syncope
Carotid sinus massage (CSM) is essential in evaluating recurrent unexplained reflex syncope, as it uniquely identifies cardioinhibitory forms that other tests may miss. CSM is largely underused in clinical practice outside dedicated syncope facilities and, when performed, its execution varies, as does the interpretation of results. Underuse affects the diagnostic yield of CSM in the syncope evaluation, thereby denying patients mechanism-based personalized treatment. There are several barriers to the proper use of CSM in the work-up of patients with unexplained syncope.To address these important limitations, an international panel of experts in the field of syncope provide herein a consensus document with the aim of offering practical guidance for the indications, contraindications, and methodology for performing carotid sinus massage in general and dedicated syncope facilities and in the emergency department.
Authors
- Viktor Hamrefors (ORCID: https://orcid.org/0000-0002-8475-0866)
- Ineke van Rossum
- Antonella Groppelli (ORCID: https://orcid.org/0009-0000-3386-6685)
- Jelle S Y de Jong (ORCID: https://orcid.org/0000-0001-9522-2455)
- Artur Fedorowski (ORCID: https://orcid.org/0000-0002-5352-6327)
- Brian Olshansky (ORCID: https://orcid.org/0000-0002-6044-045X)
- Patricia Taraborrelli
- Mohamed H. Hamdan (ORCID: https://orcid.org/0000-0002-7387-5700)
- Giulia Rivasi (ORCID: https://orcid.org/0000-0002-2736-2242)
- Piotr Kułakowski (ORCID: https://orcid.org/0000-0001-7483-3513)
- Steven van Zanten (ORCID: https://orcid.org/0009-0005-1784-9558)
- Marco Tomaino
- Alessandra Fanciulli (ORCID: https://orcid.org/0000-0002-2854-4179)
- Roland Thijs
- Melani Dani
- Jean Claude Deharo
- Robert Sheldon
- Rose Anne Kenny
- Andrea Ungar
- Vincenzo Russo
- Satish R. Raj
- Ciara Rice
- Michele Brignole
- David G. Benditt
- Roberto Maggi
- Carlos A. Morillo
- Richard Sutton
- Win-Kuan Shen
- Angel Moya
- Frederik J. de Lange (ORCID: https://orcid.org/0000-0002-7590-9230)
Institutions
- University of Iowa (US)
- Karolinska University Hospital (SE)
- University of Wisconsin–Madison (US)
- Innsbruck Medical University (AT)
- Imperial College Healthcare NHS Trust (GB)
- University of Calgary (CA)
- Lund University (SE)
- Universität Innsbruck (AT)
- Trinity College Dublin (IE)
- Aix-Marseille Université (FR)
- Leiden University Medical Center (NL)
- Hammersmith Hospital (GB)
- Karolinska Institutet (SE)
- Assistance Publique Hôpitaux de Marseille (FR)
- Ospedale di Bolzano (IT)
- Hospital Universitario Dexeus (ES)
- Reinier de Graaf Hospital (NL)
- Amsterdam Neuroscience (NL)
- Azienda Ospedaliero-Universitaria Careggi (IT)
- Presidio Ospedaliero (IT)
- Mayo Clinic in Arizona (US)
- University of Campania "Luigi Vanvitelli" (IT)
- USP Institut Universitari Dexeus (ES)
- IRCCS Istituto Auxologico Italiano (IT)
- University of Minnesota Medical Center (US)
- Skåne University Hospital (SE)
- St. James's Hospital (IE)
- Grochowski Hospital (PL)
- Stichting Epilepsie Instellingen Nederland (NL)
- Hôpital de la Timone (FR)
- University of Florence (IT)
- Imperial College London (GB)
- Libin Cardiovascular Institute of Alberta (CA)
- University of Amsterdam (NL)
Publication Details
- Journal
- Clinical Autonomic Research
- Published
- 2026-05-27
- DOI
- https://doi.org/10.1007/s10286-026-01218-z
- Primary Topic
- Cardiovascular Syncope and Autonomic Disorders
- Type
- article
- Field-Weighted Citation Impact
- 0.00