Key result
Selective cardioneuroablation eliminates swallow-induced paroxysmal AV block refractory to conservative management.
Why the study?
Swallow-induced AV block is a rare paroxysmal AV block mechanism without an established curative treatment.
Does selective cardioneuroablation prevent swallow-induced AV block in patients refractory to conservative management?
Case Report (n=1)
Does selective cardioneuroablation prevent swallow-induced AV block in patients refractory to conservative management?
Mechanism-based selective cardioneuroablation successfully suppressed symptoms in a rare case of swallow-induced paroxysmal AV block, presenting a promising therapeutic option.
Answers are grounded in this paper and cite their sources.
May offer an option for refractory swallow-induced AV block; single-case data leaves open need for prospective validation.
BACKGROUND: Swallow-induced atrioventricular (AV) block is a rare mechanism of paroxysmal AV block, and no established curative treatment currently exists. CASE SUMMARY: A 75-year-old woman without known structural heart disease presented with symptomatic paroxysmal AV block during meals. Swallowing provocation test reproducibly induced AV block at the A-H level, which was suppressed following atropine administration, suggesting a vagally mediated reflex mechanism. Despite dietary counseling, her symptoms persisted; therefore, cardioneuroablation (CNA) was performed. Among the ganglionated plexi, sites demonstrating vagal responses during high-frequency stimulation, as well as anatomically defined ganglionated plexi regions, were selectively ablated. Following the procedure, no further swallow-induced paroxysmal AV block was observed. DISCUSSION: In this case, combined selective and anatomical CNA approach was used, targeting sites considered to provide parasympathetic input to the AV node. TAKE-HOME MESSAGE: Mechanism-based selective CNA may represent a promising therapeutic option for patients with swallow-induced AV block refractory to conservative management.
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Hayashi et al. (2026) conducted a case report in Swallow-induced atrioventricular (AV) block (n=1). Selective cardioneuroablation was evaluated on Recurrence of swallow-induced paroxysmal AV block. Selective cardioneuroablation successfully eliminated swallow-induced paroxysmal AV block in a 75-year-old woman refractory to conservative management.
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