Use of a leadless pacemaker in the management of swallow syncope: A case report.

A 41-year-old male presented with syncope whilst eating and was subsequently demonstrated to have recurrent symptomatic sinus pauses whilst swallowing. Following the exclusion of structural heart disease, he was diagnosed with swallow syncope, an uncommon variant of neurocardiogenic syncope. To avoid long-term complications of a transvenous pacemaker, the case was managed with a leadless pacemaker which resulted in complete resolution of symptoms.

Deglutition Syncope Due to Exaggerated Vagal Reflex.

Swallow or deglutition syncope is an uncommon cause of syncope associated with bradyarrhythmia and hypotension during food swallowing. Early recognition of this condition is imperative but challenging. We report a case of a 60-year-old female who presented with a complaint of intermittent lightheadedness after swallowing food. An episode of presyncope was observed and a reduced pulse rate from baseline was noted when she was instructed to eat a candy bar in the clinic. Further workup revealed normal in-office electrocardiogram, bilateral carotid ultrasound, transthoracic echocardiogram, and videofluoroscopic swallow study. Our goal in presenting this case is to raise awareness of the condition in medical literature and provide a good understanding of its clinical manifestation to prevent life-threatening events.

[A case of swallow syncope associated with Parkinson disease].

A 73-year-old woman with Parkinson disease (PD) was admitted to our hospital because of aspiration pneumonia. She presented with recurrent episodes of loss of consciousness with bradycardia while swallowing solid foods or fluids. Upper endoscopy revealed a normal esophagus without hiatus hernia, cancer, diverticulum, stenosis, or achalasia. Balloon inflation at the cervical esophagus induced sinus arrest and bradycardia followed by a loss of consciousness. The diagnosis of swallow syncope (SS) was confirmed. Esophageal dilatation and an increase in the esophageal pressure induced by esophageal peristaltic disturbance associated with PD can cause SS by stimulating the vagal reflex. In addition, the head-up tilt test showed that she had orthostatic hypotension, and the coefficients of variations of the R-R intervals on electrocardiograms and the total number of beat-to-beat differences greater than 50 mseconds in the RR interval during a 24 hour ambulatory electrocardiogram were normal. The cardiovascular autonomic dysfunction characterized by the presence of sympathetic inhibition and a preserved parasympathetic function might be involved in the onset of SS. Permanent pacemaker implantation improved her clinical symptoms. The recognition of SS on the examination of a PD patient with loss of consciousness while eating is important, as PD patients might develop SS due to peristaltic disturbance and autonomic dysfunction caused by PD.

Citrus fruits induced swallow syncope with atrioventricular block or sinus arrest.

Swallow syncope is a relatively rare syndrome and caused by various foods and drinks. A 76-year-old man was admitted with frequent syncope while eating. Holter electrocardiogram revealed frequent occurrence of atrioventricular block during meals. Both atrioventricular block and sinus arrest were induced by only eating citrus fruits, citrus jelly, and acidic foods but not by other drinks and foods. These arrhythmias were suppressed after administration of atropine. No further episodes of syncope recurred after the implantation of a DDD pacemaker. This case indicated that acidic stimulation of citrus induced a vasovagal reflex via esophageal nociceptors leading to syncope.

Swallow Syncope After Whiplash Neck Injury.

Swallow syncope is a rare dysautonomic syndrome characterized by temporary loss of consciousness upon swallowing solid foods or liquids, displaying primarily in individuals with an underlying structural or functional esophageal or cardiac pathology. However, the evidence also suggests that isolated vagal dysfunction or abnormal reactions of esophageal mechanoreceptors after mechanical irritation, demyelination, or trauma can potentially evoke  a cardioinhibitory response or vasodepression upon swallowing. We present a case of a 49-year-old otherwise healthy female patient who developed swallow syncope two weeks after whiplash neck injury acquired in a rear-end collision. After no evident anatomical and/or functional cardiac or esophageal pathology was diagnosed using several diagnostic procedures, the final diagnosis was confirmed by a provocative tilt-table test while ingesting solid food. Subsequently, a dual-chamber pacemaker was implanted, relieving the patient from troublesome symptoms. Abnormal reactions of esophageal mechanoreceptors to stimuli associated with food ingestion and/or dysfunction of afferent and efferent vagal fibers due to stretch injury and related neck trauma (acquired during the car accident) may be the leading pathophysiological mechanisms of swallow syncope in our patient.

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

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.

[A case of swallow syncope]. / La syncope de déglutition : cas clinique.

Syncope accounts for nearly 5 % of the emergency intake causes. Swallow syncope is a rare form of cardio-neurogenic syncope. Less than a hundred cases were reported since its first description in the mid-18th century. We present the case of an 83-year-old patient with recurrent syncope occurring during meals. Telemetry monitoring revealed a severe bradycardia with complete AV block and a pause of 8 seconds. A dual chamber pacemaker was implanted and the syncopal episodes were abolished. We shall briefly review the diagnostic methods, mechanisms, and therapy of swallow syncope.

La syncope représente près de 5 % des causes d'admission aux urgences. La syncope de déglutition est une forme rare de syncope d'origine cardio-neurogénique : moins d'une centaine de cas ont été rapportés depuis sa première description au milieu du 18ème siècle. Nous décrivons le cas d'un patient de 83 ans qui présente, depuis plusieurs mois, des syncopes au cours des repas. L'exploration a mis en évidence un trouble du rythme de type bradycardie sévère avec un bloc auriculo-ventriculaire et une pause de plus de 8 secondes enregistrée lors de la surveillance télémétrique. L'implantation d'un pacemaker double chambre a permis de mettre fin aux épisodes syncopaux. Cet article fait le point sur les méthodes diagnostiques, les mécanismes et le traitement des syncopes de déglutition.

Swallow Syncope following Chemoradiotherapy in a Patient with Lung Cancer

Swallow or deglutition syncope is a rare cause of syncope. It occurs due to a vagal reflex while swallowing. We present here a patient with recurrent loss of consciousness after swallowing liquid. He had a 1-month history of concurrent chemoradiotherapy due to non-small cell lung cancer. Electrocardiogram monitoring revealed atrioventricular block with swallowing of beverages. The details of this case suggest that chemoradiotherapy to mediastinum may cause neurogenic swallow syncope.

Blackout during meals: A case report of swallow syncope due to sinus arrest.

A 79-year-old male, with a history of percutaneous coronary intervention (PCI), was referred to our cardiovascular department for a detailed examination of blackout caused by sinus arrest only during meals. Ultrasound echocardiography showed normal cardiac contraction with no asynergy, irrespective of the remaining stenotic coronary lesion. An electrophysiological study revealed deteriorated atrioventricular nodal conduction at a Wenckebach point of 70 beats per minute. However, sinus node function was normal as demonstrated by a sinus node recovery time of 1369 ms. Coronary angiography showed triple-vessel disease including the remaining stenotic coronary lesion, and a PCI was performed on the right coronary artery. Nevertheless, sinus arrest during meals was unchanged. Swallow syncope was partially improved by dietary modification; however, pacemaker implantation (PMI) was performed eventually, and the patient became asymptomatic after PMI. .

Cranial Nerves IX, X, XI, and XII.

This article concludes the series on cranial nerves, with review of the final four (IX-XII). To summarize briefly, the most important and common syndrome caused by a disorder of the glossopharyngeal nerve (craniel nerve IX) is glossopharyngeal neuralgia. Also, swallowing function occasionally is compromised in a rare but disabling form of tardive dyskinesia called tardive dystonia, because the upper motor portion of the glossopharyngel nerve projects to the basal ganglia and can be affected by lesions in the basal ganglia. Vagus nerve funtion (craniel nerve X) can be compromised in schizophrenia, bulimia, obesity, and major depression. A cervical lesion to the nerve roots of the spinal accessory nerve (craniel nerve XI) can cause a cervical dystonia, which sometimes is misdiagnosed as a dyskinesia related to neuroleptic use. Finally, unilateral hypoglossal (craniel nerve XII) nerve palsy is one of the most common mononeuropathies caused by brain metastases. Supranuclear lesions of cranial nerve XII are involved in pseudobulbar palsy and ALS, and lower motor neuron lesions of cranial nerve XII can also be present in bulbar palsy and in ALS patients who also have lower motor neuron involvement. This article reviews these and other syndromes related to cranial nerves IX through XII that might be seen by psychiatry.

A case of swallow syncope with sinus pause and vasovagal syncope / 대한내과학회지

A 73 year-old male presented with recurrent episodes of syncope associated with swallowing. Head up tilt test revealed positive response and electrocardiogram revealed a sinus pause with swallowing of carbonated beverages. Underlying esophageal or cardiac disease was not found after evaluation. These findings suggest that a disturbance in the autonomic feedback loop of cardiovascular reflex led to the vasovagal syncope and swallow syncope in this patient. We experienced a case of swallow syncope with sinus pause and vasovagal syncope diagnosed by head up tilt test. This is the first case in Korea that presented with both swallow syncope and vasovagal syncope.

Cases of Swallow Syncope Induced by the Activation of Mechanorecepters in the Lower Esophagus

Swallowing is a rare cause of neurally mediated syncope. The mechanism of swallow syncope that contributes to hypotension, bradycardia, or to both is complex. A 59-year-old man had experienced a recurrent loss of consciousness during swallowing of carbonated beverages or sticky foods. Another 59-year-old man had complained of intermittent syncope just after eating foods. These two patients had no significant structural or functional abnormalities in the esophagus or heart. Both cases showed bradycardia when the lower esophagus was stretched by balloon inflation. The activation of mechanoreceptors in the lower esophagus can be regarded as an initiating factor of these cardioinhibitions. The patients were treated with permanent pacemaker implantation and instructed to change eating habits, respectively.

Permanent cardiac pacemaker therapy in a patient with swallow syncope / 대한내과학회지

Syncope is sudden transient loss of consciousness and postural tone with spontaneous recovery. A 74-year-old man presented with multiple, recurrent episodes of syncope associated with swallowing beverages. Sinus pause and 2:1 atrioventricular block were induced by swallowing carbonated beverages. He was treated with permanent cardiac pacing for the prevention of syncope. Swallow syncope did not recur for one year after implantation of a cardiac pacemaker.

Permanent cardiac pacemaker therapy in a patient with swallow syncope / 대한내과학회지

Syncope is sudden transient loss of consciousness and postural tone with spontaneous recovery. A 74-year-old man presented with multiple, recurrent episodes of syncope associated with swallowing beverages. Sinus pause and 2:1 atrioventricular block were induced by swallowing carbonated beverages. He was treated with permanent cardiac pacing for the prevention of syncope. Swallow syncope did not recur for one year after implantation of a cardiac pacemaker.