Swallowing-induced atrial tachycardia is a rare phenomenon generally assumed to be caused by abnormal parasympathetic reflexes arising in the esophagus or pharynx. We describe a patient with intractable swallow tachycardia. Since certain features of the case suggested a mechanical rather than a reflex mechanism, he was treated by intrapleural repositioning of the esophagus to effect physical separation of esophagus and left atrium. Ten months after an uncomplicated procedure, the patient remains asymptomatic and free of arrhythmia.