“Be Careful What You Swallow”

Abstract

Swallow (deglutition) syncope is a rare form of neurally mediated cardioinhibitory reflex syncope occurring during swallowing. Patients may present to clinicians across multiple disciplines, so high awareness and careful evaluation are essential. We report 3 such individuals, describing our strategies in diagnosis, investigation and treatment, particularly focusing on conservative management. ( Level of Difficulty: Intermediate. )

COVID‐19 is getting on our nerves: sympathetic neural activity and haemodynamics in young adults recovering from SARS‐CoV‐2

“…The symptoms of SARS-CoV-2 infection and post-acute sequelae of SARS-CoV-2, or "long COVID," are wide-ranging, but there is emerging evidence of orthostatic intolerance with tachycardia in a number of patients (Dani et al, 2021;Raj et al, 2021;Shouman et al, 2021), and long-COVID-induced postural tachycardia syndrome has been identified by the American Autonomic Society (Raj et al, 2021) as a plausible secondary lingering illness following acute viral recovery from SARS-CoV-2 (Kanjwal et al, 2020;Miglis et al, 2020;Umapathi et al, 2020). COV+ participants in the current study did exhibit greater tachycardia during tilting than CON subjects, though the absolute HR values were not particularly abnormal.…”

Selective cardioneuroablation of the posteromedial left ganglionated plexus for drug-resistant swallow syncope with functional atrioventricular block

“…Swallow syncope is a rare form of cardioinhibitory NMS that occurs when esophageal dilatation during swallowing triggers vagus nerve overstimulation, which leads to sinus arrest and/or transient AV block, resulting in syncope. 1 , 2 Although some investigators have emphasized the importance of lifestyle changes, including avoidance of triggers and diet modification, 2 there seemed to be no apparent triggers for worsening symptoms in the present case. In addition, the patient had already undergone diet modification, avoiding potatoes and carbonated drinks.…”

“…It is caused by overactivation of the vagus nerve during swallowing of meals. 1 , 2 Because of the limited efficacy and possible adverse effects of medications and pacemakers, 3 , 4 cardioneuroablation has been proposed as an alternative therapeutic strategy for cardioinhibitory NMS, with promising preliminary results. 5 , 6 , 7 To date, however, there have been only a limited number of case reports on cardioneuroablation for swallow syncope.…”

Cardioneuroablation for swallowing-induced syncope: To pace or to ablate, that is the question

“…Swallow syncope is a rare type of reflex syncope. 1 , 2 Its pathophysiology is probably related to the stimulation of neural pathways that cause vagal hyperactivation generating syncope secondary to a combination of severe bradyarrhythmias and hypotension. 2 Diet modifications and pacemaker implant (when conservative management fails) have been the cornerstones of swallow syncope treatment.…”