Swallowing syncope: observations in the absence of conduction system or esophageal disease

A patient is described with the clinical syndrome of "swallowing syncope" who reproducibly demonstrated sinus bradycardia, A-H prolongation, and intranodal atrioventricular block in response to swallowing during electrophysiologic study. Baseline electrophysiologic and esophageal manometric results were normal, as was his response to other vagal maneuvers. Demand ventricular pacing alleviated his symptoms. These findings suggest that "swallowing syncope" is mediated via an esophageocardiac reflex and can occur in the absence of cardiac conduction system or esophageal disease.