S1939 A Rare Case of Prolonged Esophageal Food Impaction Causing Cardiac Arrhythmia

Abstract

INTRODUCTION: Atrial Fibrillation (AFib) and Supraventricular Tachycardias (SVTs) are common cardiac arrhythmias that affect millions of patients worldwide. Swallowing is not commonly associated with cardiac arrhythmias. It has been reported in previous case studies that deglutition may induce tachycardia and sustained arrhythmias. The mechanism and pathophysiology of swallowing induced tachyarrhythmias is still unclear. Here we discuss an interesting case report of food impaction causing AFib and SVT. CASE DESCRIPTION/METHODS: A 33 year old male with alcohol use disorder and history of acute dysphagia due to food impaction presented to the ED after 12 hours of food bolus impaction causing dysphagia. Similar episode occurred for the patient 5 years ago which required endoscopic removal. Prior to the procedure, the patient developed SVT in the 170s that required intravenous esmolol for resolution. ECG at the time confirmed atrial fibrillation with rapid ventricular response at rate of 125. Shortly after disimpaction, the patient spontaneously converted to normal sinus rhythm with controlled rate, with no recurrence of telemetry overnight. Of note, the patient had no past history of arrhythmias in the past, and further cardiac work up with transthoracic echocardiogram revealed an ejection fraction of 62% with mild left ventricular hypertrophy, with normal right ventricular systolic function. It was believed that his new onset arrhythmia was due to his initial presentation of acute esophageal impaction as it resolved and did not reoccur after endoscopic removal. DISCUSSION: Most common causes of new onset arrhythmias in hospitalized patients include electrolyte abnormalities, sepsis and post-surgical patients, with the most common ones being atrial fibrillation, SVT, and atrial flutter. Most recent data has shown that localized inflammation from esophageal trauma leads to a catecholamine surge that has been shown to trigger patient’s into new onset arrhythmias. This was clearly illustrated in our patient who had trauma causing localized inflammation in his esophagus by a foreign body which ultimately resolved without further medical intervention once disimpaction occurred. It is important to keep in mind that delayed endoscopic evaluation and removal in cases of food impaction can ultimately result in life threatening arrhythmias, so urgency is of utmost value in these patients. Further research needs to be performed to help patients with esophageal food impaction causing new onset cardiac arrhythmias.