May 25, 2012
Topics A-Z Heart Disease Swallow syncope and indications for permanent pacemaker implantation
Swallow syncope and indications for permanent pacemaker implantation |
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Dear Ask The Doctor: I have had swallow syncope twice in the last year. Once or twice a month I may get a pain eating. It feels like the food is moving down very slow and I feel a little dizzy. I have had a full work up with the gastroenterologist. He said that I have a small hiatal hernia. I had an event monitor that after three weeks I finally got a recording. I had an AV block ventricular standstill of 4.1 seconds. The cardiologist wants to give me a pacemaker. I found a report about swallowing syncope where the esophagus caused a compression of the left atrium. My cardiologist still believes the pacemaker is the answer. Is the report I found a possibility and I can do something other than the pacemaker? A pacemaker will not allow me to work at my job at an electrical generating plant so this is very important to me. Dear Dan: Swallow syncope is not a well recognized condition, and but several case reports exist in the literature. A case series reported one case associated with drinking a cold carbonated beverage, and the other precipitated by eating a large bolus of food. While changes in eating habits may be effective in some cases, permanent pacemaker placement is often indicated and is curative. The AV block is probably caused by a hypersensitive vagotonic reflex triggered by mechanical receptors in the lower oesophagus, resulting in suppression of the AV node, therefore leading to ventricular standstill. With a significant pause of 4.1 seconds, a pacemaker would be the definitive treatment. |
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| Last Updated ( Tuesday, 10 August 2010 ) |
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