A case of swallowing-induced atrioventricular block after myocardial infarction

We report a patient with transient atrioventricular (AV) block induced by swallowing. He complained of recurrent dizziness during meals and had suffered from inferior myocardial infarction 1 year before the onset of these symptoms. Radiologic examination showed no apparent esophageal abnormalities. Swallowing a piece of solid food or hot liquid repeatedly provoked advanced AV block. Administration of intravenous atropine sulfate prevented AV block. An electrophysiologic study revealed that this swallowing-induced AV block was an intranodal (A-H) block. We did not implant a cardiac pacemaker because his symptoms were not very serious and could be prevented by eating carefully. The patient has been symptom-free for the past 12 months. The previous myocardial infarction may be related to the appearance of this vagal-related AV block.