Case report
Swallow syncope associated with complete atrioventricular block
and vasovagal syncope
H Kakuchi, N Sato, Y Kawamura
Asahikawa Medical
College, First Department of Internal Medicine, Midorigaoka Higashi
2-1-1-1, Asahikawa, Hokkaido, 078 8510, Japan
Correspondence to: Dr Kawamura email: yk5610{at}asahikawa-med.ac.jp
Accepted 29 February
2000
A 21 year old man presented with multiple,
recurrent episodes of complete atrioventricular (AV) block associated
with swallowing. Electrophysiological study revealed an AV block with
swallowing of carbonated beverages and balloon inflation in the lower
oesophagus. Evaluation did not demonstrate any underlying oesophageal
or cardiac disease, and the AV block was not induced after intravenous
atropine administration. The AV block was probably caused by a
hypersensitive vagotonic reflex triggered by mechanical receptors in
the lower oesophagus, resulting in suppression of the AV node. Head up
tilt test revealed an increase in the high frequency spectrum of heart rate variability before the onset of the syncope. These findings suggest that the amplitude of the continual fluctuations in response to
a variety of stimuli and derangement from both intrinsic and extrinsic
environments was greater in this patient than in normal subjects.
Swallow syncope is an unusual but treatable disorder. These reflexes
that become exaggerated to the point of causing illness are poorly understood.
Keywords: swallow syncope; AV block; electrophysiological study; head up tilt test
© 2000 by Heart
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