A Rare Case Report Of Deglutition Syncope Without MajorStructural Esophageal Pathology Successfully Treated With Dual-Chamber Pacemaker Implantation

Deglutition syncope is a rare reflex-mediated condition marked by transient bradyarrhythmia or AV block triggered by swallowing. We report a 65-year-old man with a year-long history of meal-related syncope, ultimately diagnosed via Holter monitoring that revealed swallowing-induced sinus pauses. Despite no significant esophageal abnormalities on imaging, a dual-chamber pacemaker was implanted, resulting in full symptom resolution. Our findings indicate the need for careful clinical recognition of deglutition syncope and that permanent pacing can effectively prevent recurrence in selected patients with swallow- induced bradyarrhythmia. KEY CLINICAL MESSAGE: Deglutition syncope is a rare but treatable cause of reflex-mediated bradyarrhythmia triggered by swallowing. Diagnosis requires a high index of suspicion and documentation of cardioinhibitory events during meals. Permanent dual-chamber pacing offers effective symptom resolution in selected patients without reversible esophageal pathology.