Swallow Syncope Associated With Intermittent Sinus Pause and High-Degree Atrioventricular Block: A Case Report

Swallow syncope, also known as deglutition syncope, is a relatively rare neurogenic disorder that is triggered by oral intake. When diagnosed, swallow syncope is treatable, but it is challenging to identify without proper history and prior knowledge of this disorder. Here, we describe the case of a 68-year-old female with a complex history who presented to the emergency room with complaints of worsening long-term intermittent lightheadedness and dizziness associated with swallowing. During her hospital stay, the patient was noted to have a high-degree atrioventricular block on telemetry during dinner time. A repeat electrocardiogram (ECG) demonstrated a prolonged P-R interval, and a temporal relationship between swallowing cold water and electrocardiogram (ECG) changes was demonstrated. A diagnosis of swallow syncope was confirmed. Electrophysiology was consulted and a pacemaker was placed. Symptoms of swallow-associated arrhythmias completely resolved after pacemaker implantation. This case illustrates the challenging problem of swallow syncope. While swallow syncope is highly treatable once identified, the challenge lies in identifying the disorder.