Cardiac arrhythmias on swallowing

Area of Science:

• Gastroenterology
• Cardiology
• Esophageal Motility Disorders

Background:

• Cardiac arrhythmias can be associated with esophageal dysfunction.
• Incoordinate esophageal peristalsis may precipitate arrhythmias, particularly during swallowing.

Observation:

• A middle-aged male experienced swallowing-induced cardiac arrhythmias linked to esophageal incoordination.
• Barium sulfate and apple ingestion localized the trigger to the esophagogastric junction.
• Balloon distension identified the lower esophagus as the source of afferent stimuli.

Findings:

• Medical management with propranolol and quinidine sulfate offered initial symptom control.
• Surgical intervention via esophageal myotomy at the middle-lower third junction reduced symptom severity.
• The myotomy resulted in mucosal ballooning and some dysphagia.

Implications:

• Esophageal myotomy can be a therapeutic option for specific cases of swallowing-induced arrhythmias.
• Careful surgical technique is necessary to minimize post-operative complications like dysphagia.
• Further research into the neuro-esophageal-cardiac axis is warranted.