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      Non-fluoroscopic Cardioneuroablation for Deglutition-induced Syncope: Not a Bitter Pill to Swallow

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          Abstract

          Swallowing is an uncommon trigger of reflex situational syncope. We discuss the case of a 61-year-old woman who presented without a prior cardiac history complaining of 15 years of dizzy spells and hot facial flushing provoked by the swallowing of solid foods.

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          2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

          Win-Kuang Shen, Robert Sheldon, David Benditt … (2017)
          Article 0 comments Cited 127 times – based on 0 reviews     Review now
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            “Cardioneuroablation”--new treatment for neurocardiogenic syncope, functional AV block and sinus dysfunction using catheter RF-ablation

            JC Pachon, EI Pachon, TJ Lobo … (2005)
            Article 0 comments Cited 46 times – based on 0 reviews     Review now
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              Observations on recurrent syncope and presyncope in 641 patients.

              Christopher J. Mathias, Kazushi Deguchi, Irwin I Schatz (2001)
              Syncope is a common disorder that is potentially disabling and affects both young and old. Once neurological, cardiological, and metabolic causes have been excluded, there remains a group in which diagnosis is unclear; some may have an autonomic basis. We therefore did a retrospective study on consecutive patients referred to our tertiary referral autonomic centres between 1992 and 1998 with recurrent syncope and presyncope, in whom non-autonomic causes, before referral, had been sought and excluded. The object was to find out whether autonomic investigation helped diagnosis. Data from case notes and from the autonomic database on 641 patients were analysed. Syncopal patients with a known or provisional diagnosis of autonomic failure were excluded from analysis. The role of screening tests in establishing or excluding an autonomic cause was assessed. Response to additional autonomic tests (such as head-up tilt with or without venepuncture, and food challenge and exercise) was documented. Some patients underwent further testing if non-autonomic neurological, psychiatric, and other disorders were considered. Screening autonomic function tests indicated orthostatic hypotension and confirmed chronic autonomic failure in 31 (4.8%) patients. Neurally mediated syncope was diagnosed in 279 (43.5%) on the basis of clinical features and autonomic testing. Most had vasovagal syncope (227 [35%]); other causes included carotid sinus hypersensitivity (37 [5.8%]), and a group of 15 (2.3%) were associated with rarer causes such as micturition and swallowing. Miscellaneous cardiovascular causes (systemic hypotension, arrhythmias), or drugs, contributed to syncope in 53 (8.3%). Non-autonomic neurological causes included vestibular dysfunction (32 [5%]) and epilepsy (11 [1.7%]). In 56 (8.7%) a psychiatric cause was thought to be contributory. In 179 (27.9%), syncope was of unknown cause. In recurrent syncope and presyncope, when cardiac, neurological, and metabolic causes have been excluded, autonomic investigation can aid management by making, confirming, or excluding various factors or diagnoses.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Innov Card Rhythm Manag
                Journal ID (iso-abbrev): J Innov Card Rhythm Manag
                Journal ID (publisher-id): JICRM
                Title: The Journal of Innovations in Cardiac Rhythm Management
                Publisher: MediaSphere Medical (United States )
                ISSN (Print): 2156-3977
                ISSN (Electronic): 2156-3993
                Publication date (Electronic): 15 March 2023
                Publication date Collection: March 2023
                Volume: 14
                Issue: 3
                Pages: 5385-5388
                Affiliations
                [1] 1Queen’s University, Kingston Health Science Centre, Kingston, Ontario, Canada
                [2] 2Department of Cardiology, Yeditepe University, Faculty of Medicine, Istanbul, Turkey
                Author notes
                Address correspondence to: Andrés F. Miranda-Arboleda, MD, Queen’s University, Kingston Health Science Centre, 76 Stuart Street, Kingston, ON K7L 2V7, Canada. Email: mirandaarboleda@ 123456gmail.com .

                The author reports no conflicts of interest for the published content. No funding information was provided. This case was previously presented at the 2022 EP Fellows Summit Abstract Competition.

                Article
                Publisher ID: icrm.2023.14037
                DOI: 10.19102/icrm.2023.14037
                PMC ID: 10044778
                PubMed ID: 36998418
                SO-VID: f3313f31-4fdf-4af8-8f28-a233a8734cfc
                Copyright © Copyright: © 2023 Innovations in Cardiac Rhythm Management
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 01 November 2022
                Date accepted : 07 November 2022
                Categories
                Subject: Case Report

                Keywords: cardioneuroablation,syncope,zero fluoroscopy
                Data availability:
                Keywords: cardioneuroablation, syncope, zero fluoroscopy

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