Swallow syncope after aneurysmectomy of the thoracic aorta

A case of swallow syncope is presented and 30 previously reported cases from the literature in English are reviewed. A 67-year-old male developed syncope on swallowing 3 months after the resection of an aneurysm of the descending thoracic aorta. Electrocardiographic monitoring during eating demonstrated sinus bradycardia and sinus arrest with loss of consciousness. Neither Valsalva's maneuver nor carotid massage could produce bradycardia or syncope. Intravenous administration of edrophonium produced sinus bradycardia and the drinking of water by the patient after edrophonium administration brought about sinus bradycardia and sinus arrest with loss of consciousness. Sinoatrial node and atrioventricular node functions, evaluated by an atropine test, overdrive suppression test, and His bundle electrocardiogram were normal. No pathological changes were observed following a barium swallow. The patient was treated with a permanent pacemaker.