Carotid sinus pressure: a new application of an old maneuver. A preliminary report

This study reveals the capability of carotid sinus pressure (CSP) in distinguishing aberrant ventricular complexes from ventricular ectopy in atrial fibrillation. Nine patients with atrial fibrillation and frequent (>10/min) single and/or repetitive wide QRS-complexes (duration > 0.12 s) participated. None of them were on antiarrhythmic medication, included digitalis. CSP was performed during ECG monitoring and the response to it was arbitrarily designated positive if it resulted in slowing of the ventricular rate and a temporary abolition of wide QRS-complexes. The origin of wide QRS-complexes was verified by an i.v. bolus of adenosine and/or lidocaine. Our results showed that CSP resolved aberrant beats in 85.7% (six of seven patients) and had high specificity (100%), accuracy (88.9%) and predictive value (100%). In conclusion, CSP can be used as a simple bedside technique to distinguish the origin of wide QRS-complexes.