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Carotid sinus hypersensitivity (CSH) is diagnosed with an asystolic or hypotensive response during carotid sinus massage.It has been attributed to unexplained falls and syncope, and is rare before the age of 50years but affects up to 50% of 90 year olds with unexplained falls or syncope.Treatment with the implantation of a dual-chamber permanent pacemaker confers symptom relief.The underlying mechanism of CSH is currently poorly understood.Recent epidemiological data suggests that 39% of community dwelling older people aged >65years have CSH, but not all of these individuals complain of symptoms of dizziness, falls or syncope.Autonomic evaluation suggests that CSH is associated with autonomic dysfunction and that impaired cerebral autoregulation accounts for the symptomatic presentation of this disorder.