Swallowing-Induced Atrial Tachycardia Presenting with Syncope in an Elderly Woman: A Case Report and Management Challenge

Abstract

Background: Swallowing-induced atrial tachycardia is a rare condition with variable presentations; syncope is uncommon. Radiofrequency catheter ablation is considered definitive, but management should be individualized, and medical therapy may be appropriate when ablation is not feasible.
Case Presentation: A 78-year-old woman presented with syncope, dizziness, and lightheadedness during meals. Extensive evaluation-including electrocardiography, echocardiography, carotid Doppler ultrasound, chest computed tomography, and laboratory tests-was unremarkable. A 24-hour Holter monitor showed recurrent short runs of atrial tachycardia alternating with sinus rhythm. Episodes consistently occurred during meals and were absent outside eating periods. Continuous monitoring during food intake confirmed swallowing-triggered atrial tachycardia. Although catheter ablation was recommended given the high-risk presentation, the patient declined. Low-dose amiodarone was initiated because of her low baseline heart rate. After 4 weeks, symptoms resolved completely, and repeat Holter showed only a single brief episode. Therapy was switched to bisoprolol (2.5 mg daily) to minimize long-term toxicity. At 12-week follow-up, she remained asymptomatic without adverse effects.
Conclusions: Syncope is a rare manifestation of swallowing-induced tachyarrhythmia. Medical therapy may be an effective alternative, particularly when catheter ablation is unavailable or declined.