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      Sequential Use of Aminophylline and Theophylline for Temporizing Neck Cancer-Induced Carotid Sinus Syncope

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          Abstract

          Carotid sinus syncope due to head and neck cancer is uncommon and the management is challenging. Permanent pacemaker implantation is generally considered but malnutrition with subsequent chemo-radiation increases the risk of device infection. This is a first case report of the sequential use of aminophylline and theophylline for pharmacological temporization. ( Level of Difficulty: Advanced.)

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          Abstract

          Carotid sinus syncope due to head and neck cancer is uncommon and the management is challenging. Permanent pacemaker implantation is generally…

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          Cardiac implantable electronic device infections: Who is at greatest risk?

          Parijat Joy, Gagan Kumar, Jeanne Poole … (2017)
          Cardiac implantable electronic device (CIED) infections are associated with hospitalization, mortality, increased costs, and adverse outcomes.
          Article 0 comments Cited 25 times – based on 0 reviews     Review now
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            Effects of Permanent Pacemaker and Oral Theophylline in Sick Sinus Syndrome : The THEOPACE Study: A Randomized Controlled Trial

            M Brignole, P Alboni, C Menozzi … (1997)
            Pacemakers and theophylline are currently being used to relieve symptoms in patients with sick sinus syndrome (SSS). However, the impact of either therapy on the natural course of the disease is unknown. We conducted a randomized controlled trial to prospectively assess the effects of pacemakers and theophylline in patients with SSS.
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              Syncope from head and neck cancer.

              James Strong, Morten Nielsen, Anna D. MacDonald … (1982)
              We have examined 17 patients suffering from recurrent syncope caused by carcinoma of the head and neck. The tumor originated in the mouth in seven, larynx in six, nasopharynx in three and parotid gland in one, and involved cervical lymph nodes at diagnosis in 12. Sixteen patients had previously had radical neck dissections and 12 had had radiation therapy. Recurrent carcinoma was present in 16. Spells resolved spontaneously in four, improved with treatment in 11 and continued in two. The syncope was spontaneous in 15 and induced only by suctioning or carotid sinus massage in two. Suctioning also produced attacks in four others, as did carotid sinus massage in five of ten tested. Acute severe unilateral head or neck pain preceded spontaneous syncope in 11. Sixteen patients had both profound bradycardia and hypotension during most spells, but ten had syncope with hypotension only, either spontaneously or following cardiac pacing or atropine to prevent bradycardia. Seizure activity accompanied syncope in eight. Anticholinergics improved 7/12, carbamazepine 2/5, carotid ligation 1/1 and intracranial sectioning of the glossopharyngeal nerve 1/1. Local radiation may have helped 4/10. Cardiac pacing was ineffective in 3/3 due to the development of pure vasodepressive syncope. Autopsy in 2/2 showed tumor involving the glossopharyngeal and vagus nerves. Syncope in these patients is under-recognized, frequently is due to vasodepression, and suggests recurrent carcinoma.
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                Author and article information

                Contributors
                Judith A. Mackall
                Journal
                Journal ID (nlm-ta): JACC Case Rep
                Journal ID (iso-abbrev): JACC Case Rep
                Title: JACC Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2666-0849
                Publication date PMC-release: 13 November 2019
                Publication date Collection: December 2019
                Publication date (Electronic): 13 November 2019
                Volume: 1
                Issue: 4
                Pages: 612-615
                Affiliations
                [a ]Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
                [b ]Division of Cardiology, Case Western Reserve University, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
                [c ]Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
                Author notes
                [∗ ] Address for correspondence: Dr. Judith A. Mackall, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, Ohio 44106. Judith.Mackall@ 123456UHhospitals.org
                Article
                Publisher Item ID: S2666-0849(19)30370-5
                DOI: 10.1016/j.jaccas.2019.09.017
                PMC ID: 8288761
                PubMed ID: 34316890
                SO-VID: 0701665e-148c-415c-a98d-846e908496f1
                Copyright © © 2019 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 11 July 2019
                Date revision received : 6 September 2019
                Date accepted : 11 September 2019
                Categories
                Subject: Case Report
                Subject: Clinical Case

                Keywords: aminophylline,carotid sinus syncope,neck cancer,pharmacological temporization,sequential use,theophylline,cr, chemo-radiation,css, carotid sinus syncope,ppm, permanent pacemaker,sss, sick sinus syndrome
                Data availability:
                Keywords: aminophylline, carotid sinus syncope, neck cancer, pharmacological temporization, sequential use, theophylline, cr, chemo-radiation, css, carotid sinus syncope, ppm, permanent pacemaker, sss, sick sinus syndrome

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