Ectopic atrial tachycardia on swallowing. Report on favourable effect of verapamil

A female patient who suffered from atrial tachycardia associated with the ingestion of food or drink was examined in our department. No signs of organic heart disease were discovered, oesophageal motility was normal, but X-ray revealed a small hiatal hernia. The arrhythmia started with an atrial extrasystole arising well outside the functional refractory period of the AV node, and it could be reproduced by inflation of a balloon. It is suggested that the arrhythmia is induced by a mechanical effect of the passage of food on the left atrial wall. Several drugs were tried in order to stop or relieve the complaints. None of them prevented or stopped the atrial tachycardia but verapamil and edrophonium chloride caused 2:1 AV block, and follow-up study has shown that sufficient doses of verapamil are able to relieve the patient's complaints.