Swallow Syncope Associated with Complete Atrioventricular Block: A Case Report and Review of the Literature

Swallow or deglutition syncope is a very unusual but treatable disorder. A 44-year-old male presented with multiple, recurrent episodes of complete atrioventricular block associated with swallowing. Over a 24-hour period, 92 episodes of complete atrioventricular block occurring with meals were recorded by Holter monitoring. Evaluation did not demonstrate any underlying esophageal or cardiac disease. A trial of anticholinergic medications was unsuccessful. The patient's symptoms resolved following placement of a demand cardiac pacemaker. This is a rare but potentially lethal disorder that can be successfully treated if recognized. Physicians should be alerted to symptoms of lightheadedness or syncope during meals.