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Published on: March 15, 2020
Ice-cold beer-triggered swallow syncope with reproducible supra-Hisian AV block documented by intracardiac recordings
Daisuke Sato1, Kumi Uchimura1, Takashi Katashima2
1Arrhythmia Center, Tenyoukai Central Hospital, Kagoshima, Japan.
Introduction:
Swallow syncope is a rare situational syncope caused by an exaggerated vagal reflex and may result in bradyarrhythmia or atrioventricular block.
Methods:
A 63-year-old man with recurrent syncope triggered by beer ingestion underwent cardiovascular, gastrointestinal, ambulatory electrocardiographic, and electrophysiological evaluation, including provocation testing.
Results:
Only ice-cold beer reproducibly induced transient AH block. Other foods and beverages, including cold soda, cold sake, and room-temperature beer, were negative. Ambulatory monitoring documented a symptomatic 7.9-second pause. Disopyramide was ineffective. Permanent pacemaker implantation prevented recurrent symptoms despite repeat provocation.
Discussion:
This case highlights a highly specific trigger for swallow syncope and the diagnostic value of targeted provocation testing.
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