Key result
Pacemaker and medical therapy restore normal sinus rhythm and resolve throat pain in swallow syncope.
Why the study?
Recurrent syncopal attacks associated with swallowing and right-sided throat pain with asystolia represent a rare clinical presentation requiring detailed evaluation and management.
Case Report (n=1)
Swallow syncope can be associated with inflammatory conditions such as periodontitis and oesophagitis, and treating the underlying cause may resolve the arrhythmias.
Answers are grounded in this paper and cite their sources.
Suggests screening for inflammatory triggers in swallow syncope; leaves open whether targeted therapy avoids pacing in broader populations.
A 63-year-old man presented with recurrent syncopal attacks associated with swallowing and right-sided throat pain. Immediately after admission, he presented a 16-s asystolia. The patient's clinical history was unremarkable except for previous postimplant periodontitis. Several episodes of severe bradycardia and sinus pauses, always associated with painful deglutition, were recorded subsequently. X-ray orthopanthomography and magnetic resonance imaging of the neck confirmed several areas of periodontitis around the previous dental implants and right mastoid inflammation. A barium swallow and fibre-optic endoscopy also revealed a small sliding hiatus hernia and distal chronic oesophageal inflammation. Despite complete dental curettage, antibiotics and antigastro-oesophageal reflux therapy, only partial relief of the pain and incomplete resolution of the arrhythmic disorder were obtained after 3 weeks, and the patient underwent pacemaker implantation. At 1-month follow-up, however, he reported the complete relief of the throat pain; subsequent Holter monitoring showed normal sinus rhythm, without pacemaker-induced electrical activity.
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Favaretto et al. (2008) conducted a case report in Swallow syncope and right-sided throat pain (n=1). Pacemaker implantation and medical/dental therapy was evaluated on Relief of throat pain and resolution of arrhythmic disorder. In a 63-year-old man with swallow syncope, pacemaker implantation and medical therapy led to complete relief of throat pain and normal sinus rhythm at 1-month follow-up.
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