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Cardioneuroablation for swallowing-induced syncope: to pace or to ablate, that is the question. HeartRhythm Case Rep 2023. [DOI: 10.1016/j.hrcr.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Siew KSW, Tan MP, Hilmi IN, Loch A. Swallow syncope: a case report and review of literature. BMC Cardiovasc Disord 2019; 19:191. [PMID: 31391000 PMCID: PMC6686266 DOI: 10.1186/s12872-019-1174-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 07/31/2019] [Indexed: 11/25/2022] Open
Abstract
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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Affiliation(s)
- Kelvin Shenq Woei Siew
- Department of Medicine/Cardiology, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
| | - Maw Pin Tan
- Department of Medicine/Geriatric, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ida Normiha Hilmi
- Department of Medicine/Gastroenterology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Alexander Loch
- Department of Medicine/Cardiology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Aydogdu I, Hasdemir C, Acarer A, Alpaydin S, Ertekin C. Swallow-induced syncope in 5 patients: Electrophysiologic evaluation during swallowing. Neurol Clin Pract 2017; 7:316-323. [PMID: 29185536 DOI: 10.1212/cpj.0000000000000376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/17/2017] [Indexed: 12/14/2022]
Abstract
Background We sought to characterize a cohort of participants with swallow-induced syncope (SIS) with clinical and electrophysiologic evaluations. Methods Using electrocardiographic monitoring and neurophysiologic methods of swallowing, we evaluated a cohort of 5 patients with SIS, 4 of whom had longitudinal follow-up. Results We determined electrophysiologically that the duration between the onset of swallow and a bradyarrhythmia or asystole is extremely short (2-3 seconds) in SIS. Most participants with SIS do not have a neurologic or esophageal disorder. SIS can occur with different food types, in sitting or standing position, and has varying frequency in different participants. Permanent pacemaker placement is a curative measure in SIS. Conclusions Our findings suggest that SIS is elicited by reflex afferent pathways originating in the oropharynx, rather than an esophageal origin, as previously proposed. Our longitudinally followed cohort with detailed clinical and electrophysiologic characterization should aid the clinician in the diagnosis and treatment of this potentially life-threatening condition.
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Affiliation(s)
- Ibrahim Aydogdu
- Departments of Neurology and Clinical Neurophysiology (IA, CE), Cardiology (CH), and Neurology (AA, SA), Ege University, Bornova/Izmir, Turkey
| | - Can Hasdemir
- Departments of Neurology and Clinical Neurophysiology (IA, CE), Cardiology (CH), and Neurology (AA, SA), Ege University, Bornova/Izmir, Turkey
| | - Ahmet Acarer
- Departments of Neurology and Clinical Neurophysiology (IA, CE), Cardiology (CH), and Neurology (AA, SA), Ege University, Bornova/Izmir, Turkey
| | - Sezin Alpaydin
- Departments of Neurology and Clinical Neurophysiology (IA, CE), Cardiology (CH), and Neurology (AA, SA), Ege University, Bornova/Izmir, Turkey
| | - Cumhur Ertekin
- Departments of Neurology and Clinical Neurophysiology (IA, CE), Cardiology (CH), and Neurology (AA, SA), Ege University, Bornova/Izmir, Turkey
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Okahara A, Nagamoto Y, Umemoto S, Matsuura T, Ozaki K, Nakano Y, Takegami K, Mine D, Shirahama T, Koga Y, Yoshida K, Sadamatsu K, Hayashida K. Blackout during meals: A case report of swallow syncope due to sinus arrest. J Cardiol Cases 2014; 10:91-93. [PMID: 30546515 DOI: 10.1016/j.jccase.2014.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/10/2014] [Accepted: 05/12/2014] [Indexed: 11/17/2022] Open
Abstract
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. <Learning objective: Swallow syncope is a rare cause of syncope that belongs to the neurally mediated reflex syncopal syndromes, which can induce a variety of bradyarrhythmias: sinus bradycardia, sinus arrest, sinoatrial block, atrioventricular block, or atrial and ventricular asystole. In this case, we demonstrated that dietary modification or pacemaker implantation improved swallow syncope due to sinus arrest.>.
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Affiliation(s)
- Arihide Okahara
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | | | - Shintaro Umemoto
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Taku Matsuura
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Koji Ozaki
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Yasuhiro Nakano
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Kaoru Takegami
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Daigo Mine
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | | | - Yasuaki Koga
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Keiki Yoshida
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Kenji Sadamatsu
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Kiyoshi Hayashida
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
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Abstract
Swallow or deglutition syncope is a relatively rare syndrome. It is a vagally mediated syncope induced by swallowing. Swallow syncope may occur in all age groups and, when diagnosed, is treatable. A woman, aged 60 years, presented with an episode of a syncopal attack associated with swallowing a sandwich. She had a 6-month history of recurrent episodes of lightheadedness while eating solid foods. Telemetry monitoring demonstrated several episodes of severe bradycardia and complete atrioventricular block with up to a 7.0 second pause associated with meals. Computed tomography of the head and neck revealed no significant findings, and barium esophagram was normal. Echocardiogram was within normal limits. Her symptoms resolved after permanent pacemaker placement. Herein, we review the diagnosis, mechanism, and management of swallow syncope.
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Affiliation(s)
- Subhashis Mitra
- Department of Internal Medicine, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - Tiffany Ludka
- Department of Medicine-Pediatrics, Marshfield Clinic, Marshfield, Wisconsin, USA
| | | | - Param P. Sharma
- Department of Cardiology, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - Jiangming Luo
- Department of Hospital Medicine, Marshfield Clinic, Marshfield, Wisconsin, USA
- Corresponding Author: Jiangming Luo, MD, PhD, Marshfield Clinic, Department of Hospital Medicine, 1000 N Oak Ave, Marshfield WI 54449, Tel: (715) 387-5537,
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