Literature DB >> 28491734

To the Editor-Swallowing-induced atrial tachycardia arising from superior vena cava: significant involvement of parasympathetic nerve activity.

Bor Antolic1, David Zizek1.   

Abstract

Entities:  

Year:  2016        PMID: 28491734      PMCID: PMC5419962          DOI: 10.1016/j.hrcr.2016.05.009

Source DB:  PubMed          Journal:  HeartRhythm Case Rep        ISSN: 2214-0271


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We read with great interest the case report of swallowing-induced atrial tachycardia (AT) by Higuchi et al. The arrhythmia was refractory to pharmacologic treatment; however, the drugs used were not specified. Subsequently, an electrophysiological study was performed and the swallowing-induced focal trigger was localized in the superior vena cava and was successfully ablated. We would like to share our case of a 71-year-old man with 1-month history of swallowing-induced syncope. Short bursts of presyncope inducing AT during swallowing were recorded at lunch time. We found no pathology on echocardiography, stress testing, or upper gastrointestinal barium swallow study. Drug treatment with beta blockers was ineffective. Because the mechanism of swallowing-induced syncope was presumed to be vagally mediated, we attempted treating the patient with disopyramide owing to its vagolytic properties, as was already decribed in the literature [2]. After 2 days of therapy with slow-release disopyramide 250 mg twice a day, the patient reported complete abolition of symptoms. To confirm the causal effect, the drug was discontinued and the symptoms recurred almost immediately. Three months after hospital discharge we contacted the patient and found out that he stopped taking the medication and did not experience any palpitations or syncope. We confirmed the complete absence of AT with 72-hour Holter monitoring. Several case reports in the literature address effective pharmacologic therapy of swallowing-induced arrhythmias with remissions lasting even after its termination.2, 3, 4 Therefore, we would like to stress that in similar cases treatment should be principally focused on antiarrhythmic drugs with known vagolytic action, since spontaneous remissions are possible and catheter ablation is an invasive procedure with few, but potentially serious, complications.
  4 in total

1.  Swallowing induced atrial fibrillation.

Authors:  Neil S Baman; Timir S Baman; William Taddonio
Journal:  Pacing Clin Electrophysiol       Date:  2004-04       Impact factor: 1.976

2.  Deglutition-induced atrial fibrillation.

Authors:  Amyn Malik; Syed Sohail Ali; Amin Rahmatullah
Journal:  Tex Heart Inst J       Date:  2005

3.  Deglutition induced atrial tachycardia and atrial fibrillation.

Authors:  Yousuf Kanjwal; Naser Imran; Blair Grubb
Journal:  Pacing Clin Electrophysiol       Date:  2007-12       Impact factor: 1.976

4.  Swallowing-induced atrial tachycardia arising from superior vena cava: Significant involvement of parasympathetic nerve activity.

Authors:  Koji Higuchi; Kenzo Hirao; Hitoshi Hachiya; Mitsuaki Isobe
Journal:  HeartRhythm Case Rep       Date:  2016-03-31
  4 in total

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