Swallowing-induced tachycardia: electrophysiologic and pharmacologic observations

A 38-year-old man developed palpitations after swallowing. Intracardiac recordings and esophageal manometry were obtained during episodes of swallowing-induced tachycardia. These studies demonstrated that the site of origin of the tachycardia was the high right atrium and that the onset of the tachycardia occurred prior to the arrival of the peristaltic wave in the esophagus. Evaluation of the tachycardia revealed that the likely mechanism for the tachycardia was triggered automaticity. Autonomic blockade and other pharmacologic interventions failed to prevent episodes of tachycardia. Swallowing-induced tachycardia is a rare disorder triggered by an undefined neural reflex arc.