Swallowing Induced Atrial Tachycardia (SIAT) is a rare clinical entity with an incidence of 0.6% among paroxysmal atrial arrhythmias. It is usually seen in middle aged males and is associated with structurally normal hearts. The tachycardia originally thought to be related to a mechanical effect of the esophagus on the left atrium was shown under ICE to initiate with swallowing but before peristalsis. Recent data from heart rate variability analyses also indicate a surge in parasympathetic activity prior to induction of tachycardia.