Swallow syncope caused by third-degree atrioventricular block

Aaberg, Anne Marie Roust; Eriksson, Anna Elin; Madsen, Per; Dixen, Ulrik

doi:10.1136/bcr-2015-211441

Cited by 3 publications

(1 citation statement)

References 14 publications

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“…The first description of deglutition syncope is attributed to a report by Spens in the late 18th century . Thereafter, more than 100 years passed before Sir James Mackenzie, in his 1913 treatise on diseases of the heart, provided the first recordings documenting physiological abnormalities occurring during swallow syncope.…”

Section: Introductionmentioning

confidence: 99%

Swallow (deglutition) syncope: An evaluation of swallowing‐induced heart rate and hemodynamic changes in affected patients and control subjects

Kohno

Adkisson

Detloff

et al. 2018

Cardiovasc electrophysiol

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Background: Syncope triggered by swallowing is a well-known but uncommon condition that has been the focus of case reports but is otherwise largely unstudied. To better understand swallow syncope we examined heart rate (HR) and blood pressure (BP) changes during swallowing in clinically suspected swallow syncope patients and asymptomatic control subjects. Methods: The study population comprised four individuals with a history suggesting swallow syncope (three men, 53 ± 14.9 years) and 15 (nine men, 46 ± 17.1 years, P = NS vs patients) asymptomatic volunteer control subjects. Studies in all individuals comprised noninvasive beat-to-beat HR and BP measurement during swallowing 150 mL of cold liquid while standing. Additional tests in swallow syncope patients included: active standing, Valsalva maneuver, carotid sinus massage (CSM), and headup tilt (HUT).Results: Swallowing resulted in a greater decrease of both HR (−22 ± 22.1 vs −3 ± 11.7 beats/minute [bpm]; P = 0.045) and BP (−22 ± 17.4 vs − 2 ± 11.8; P = 0.036) in swallow syncope patients than in controls. Further, in swallow syncope patients the time to lowest HR and BP differed (9 ± 5.5 vs 19 ± 7.2 seconds; P = 0.02), suggesting that both cardioinhibitory (CI) and vasodepressor (VD) mechanisms are present but operate independently. Other autonomic studies were normal in swallow syncope patients except for CSM pause more than 3 seconds in two patients.Conclusion: Swallow syncope is associated with transient and temporally independent CI and VD features, consistent with reflex syncope. Potentially, a swallowing test during autonomic evaluation may be useful to unmask relative magnitudes of CI and VD responses, thereby facilitating treatment strategy decisions. K E Y W O R D S autonomics, head-up tilt, swallowing, syncope J Cardiovasc Electrophysiol. 2019;30:221-229. wileyonlinelibrary.com/journal/jce How to cite this article: Kohno R, Adkisson WO, Detloff BLS, Sakaguchi S, Benditt DG. Swallow (deglutition) syncope: An evaluation of swallowing-induced heart rate and hemodynamic changes in affected patients and control subjects.

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Section: Introductionmentioning

confidence: 99%

Swallow (deglutition) syncope: An evaluation of swallowing‐induced heart rate and hemodynamic changes in affected patients and control subjects

Kohno

Adkisson

Detloff

et al. 2018

Cardiovasc electrophysiol

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Swallow presyncope in an athletic patient caused by third-degree atrioventricular block

Damme

Backer

Vanderheeren

2017

Acta Clinica Belgica

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Introduction Swallow syncope is a neurally mediated syncope. Multiple causes have been described in literature. A rare cause is arrhythmias. Only a limited amount of cases present the association of swallow syncope and third degree AV-block. Case presentation A 39-year-old man presented with episodes of presyncope while eating. Further medical history, physical examination, resting 12-lead ECG, cyclo-ergometry, transthoracic echocardiography and MRI of the heart were normal. 24 h Holter monitoring demonstrated high-grade third-degree atrioventricular (AV) block. The patient was scheduled for pacemaker implantation. Discussion Arrhythmia is a rare cause of swallow syncope. Reported arrhythmic causes are sinus bradycardia, sinoatrial block, atrioventricular block and complete atrial and ventricular asystole. Essential to the diagnosis is that (pre)syncope is preceded by swallowing and documentation of AV block on 24 h Holter monitoring. Treatment is guided by ESC guidelines which state that reflex syncope has a grade IIa recommendation for pacing, while current evidence suggests that asymptomatic vagally mediated AV block should not be treated until symptomatic.

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Swallow syncope: a case report and review of literature

Siew

Tan

Hilmi

et al. 2019

BMC Cardiovasc Disord

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Background Swallow or deglutition syncope is an unusual type of neurally-mediated syncope associated with life-threatening bradyarrhythmia and hypotension. It is a difficult condition to diagnose with commonly delayed diagnosis and management. There is lack of review articles that elucidate the basic demographics, clinical characteristics and management of this rare condition. This publication systematically reviews the 101 case reports published since 1793 on swallow syncope. Case presentation A 59-year-old man presented with the complaint of recurrent dizziness associated with meals. A 24-h ambulatory ECG recording confirmed an episode of p-wave asystole at the time of food intake. Oesophagogastroduodenoscopy with balloon inflation in the mid to lower oesophagus resulted in a 5.6 s sinus pause. The patient’s symptoms resolved completely following insertion of a permanent dual chamber pacemaker. Conclusions Swallow syncope is extremely rare, but still needs to be considered during diagnostic workup. It is commonly associated with gastro-intestinal disease. Permanent pacemaker implantation is the first line treatment.

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Swallow syncope caused by third-degree atrioventricular block

Abstract: We report a case of a patient with more than 30 years of repeated syncopes, always following food intake. The patient was diagnosed with a swallow-related third-degree atrioventricular block and successfully treated with an artificial pacemaker.

Cited by 3 publications

References 14 publications

Swallow (deglutition) syncope: An evaluation of swallowing‐induced heart rate and hemodynamic changes in affected patients and control subjects

Swallow (deglutition) syncope: An evaluation of swallowing‐induced heart rate and hemodynamic changes in affected patients and control subjects

Swallow presyncope in an athletic patient caused by third-degree atrioventricular block

Swallow syncope: a case report and review of literature

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