Abstract
BackgroundSwallow 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 presentationA 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.ConclusionsSwallow 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.
Highlights
Swallow or deglutition syncope is an unusual type of neurally-mediated syncope associated with lifethreatening bradyarrhythmia and hypotension
We present a case of recurrent swallow syncope with a review and summary of the entire literature available regarding this rare condition
Swallow syncope is more common in males (59.4%, n = 60), and in the older age group (55.4%, n = 56, more than 60 years old)
Summary
Swallow syncope is a rare cause of a neurally mediated syncope that is frequently associated with life-threatening bradyarrhythmia [1]. The patient described a sensation of increasing difficulty in swallowing despite reducing the size of his meals He denied any associated syncope or seizures. A 20 mm diameter TTS (through-the-scope), CRETM (controlled radial expansion) balloon (Boston scientific) was sequentially inflated in the proximal, mid and distal esophagus while the pacemaker was programmed “OFF” to assess the physiologic response. Inflation in both distal and mid oesophagus resulted in significant sinus pauses of up to 5.6 s (Fig. 3c) confirming the cardio-inhibitory response to oesophageal distension as the underlying pathophysiological mechanism of this patient’s syncopal events
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