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Deglutition syncope: a rare cause of reflex syncope
Otto Fenske1, John P Foran2, Salma Nowell3
1Undergraduate Education Department, Epsom and Saint Helier University Hospitals NHS Trust, London, UK otto.fenske@nhs.net.
BMJ Case Reports
|November 10, 2025
Summary
Deglutition syncope, a rare condition causing fainting during eating, was diagnosed in a young woman. Treatment with a pacemaker effectively resolved her symptoms, highlighting the importance of prompt diagnosis and intervention.
Area of Science:
- Cardiology
- Neurology
- Gastroenterology
Background:
- Deglutition syncope is a rare condition characterized by syncope triggered by swallowing.
- It is often associated with a significant vagal response leading to cardioinhibition.
- This case highlights a prolonged diagnostic journey in a young patient with atypical symptoms.
Purpose of the Study:
- To present a rare case of deglutition syncope in a young woman.
- To illustrate the diagnostic challenges and successful management of this condition.
- To discuss potential treatment options including pacemaker implantation and cardioneuroablation.
Main Methods:
- Detailed patient history including a ten-year history of presyncope and visual disturbances.
- Diagnostic investigations included resting 12-lead ECG and ambulatory Holter monitoring.
- Provocative testing during eating, response to intravenous atropine, and exclusion of gastrointestinal pathology.
Main Results:
- The patient experienced reproducible, high-grade atrio-ventricular (AV) block with ventricular asystole during eating.
- Symptoms were abolished by intravenous atropine, confirming a vagally mediated process.
- Dual-chamber pacemaker implantation resulted in complete resolution of symptoms.
Conclusions:
- Deglutition syncope requires thorough history-taking and diagnostic evaluation, including provocative testing.
- Vagal dysfunction is a key mechanism, responsive to anticholinergic agents and pacing.
- Pacemaker implantation offers a definitive treatment for refractory cases, improving quality of life.
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