Reply to the Editor - Regarding swallowing-induced atrial tachycardia arising from superior vena cava: Significant involvement of parasympathetic nerve activity.

We appreciate Drs Antolic and Zizek for giving us great comments regarding our case of swallowing-induced atrial tachycardia. With great interest, we read the case shown in the letter. Because this arrhythmia was known to relate to autonomic nerve activity and there were case reports in which beta blockers or class Ia antiarrhythmic drugs with vagolytic properties were effective, we tried bisoprolol, carvedilol, and disopyramide for this patient. However, all drugs were refractory to this arrhythmia and the patient was quite symptomatic, as this arrhythmia occurred almost every time he swallowed. Therefore, according to several reports of swallowing atrial tachycardia that can be treated by catheter ablation,4, 5 we undertook this procedure with the patient as a curative therapy as soon as possible. The case that Drs Antolic and Zizek showed was very interesting and gave us important input regarding treatment of swallowing-induced atrial tachycardia. However, we still do not know who can be treated using antiarrhythmic drugs or how long we should use antiarrhythmic drugs. Also, the effect of antiarrhythmic drugs is not stable. Therefore, we should consider catheter ablation as soon as possible when antiarrhythmic drugs are ineffective, since the success rate of catheter ablation is very high.