Swallowing-Induced Atrial Tachyarrhythmia Triggered by Solid Foods
2014; Lippincott Williams & Wilkins; Volume: 130; Issue: 13 Linguagem: Inglês
10.1161/circulationaha.114.010235
ISSN1524-4539
AutoresKazuyuki Tanoue, Masahiro Sonoda, Erika Yamashita, Hideki Tanaka, Norihito Nuruki,
Tópico(s)Gastroesophageal reflux and treatments
ResumoHomeCirculationVol. 130, No. 13Swallowing-Induced Atrial Tachyarrhythmia Triggered by Solid Foods Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBSwallowing-Induced Atrial Tachyarrhythmia Triggered by Solid Foods Kazuyuki Tanoue, MD, Masahiro Sonoda, MD, Erika Yamashita, MD, Hideki Tanaka, MD and Norihito Nuruki, MD Kazuyuki TanoueKazuyuki Tanoue From the 2nd Division of Cardiovascular Medicine, National Hospital Organization, Kagoshima Medical Center, Kagoshima, Japan. , Masahiro SonodaMasahiro Sonoda From the 2nd Division of Cardiovascular Medicine, National Hospital Organization, Kagoshima Medical Center, Kagoshima, Japan. , Erika YamashitaErika Yamashita From the 2nd Division of Cardiovascular Medicine, National Hospital Organization, Kagoshima Medical Center, Kagoshima, Japan. , Hideki TanakaHideki Tanaka From the 2nd Division of Cardiovascular Medicine, National Hospital Organization, Kagoshima Medical Center, Kagoshima, Japan. and Norihito NurukiNorihito Nuruki From the 2nd Division of Cardiovascular Medicine, National Hospital Organization, Kagoshima Medical Center, Kagoshima, Japan. Originally published23 Sep 2014https://doi.org/10.1161/CIRCULATIONAHA.114.010235Circulation. 2014;130:e113–e115IntroductionA 51-year-old woman had a 1-year history of recurrent episodes of presyncope while eating. She received treatment for vertigo, but symptoms did not improve. Because she also had dimmed vision, she was admitted to our hospital. There were no abnormal findings on physical examination and blood tests. Her resting 12-lead ECG showed sinus rhythm and no abnormality (Figure 1). Transthoracic echocardiography revealed normal left ventricular function and no structural heart disease (Figure 2, Movie IA and IB in the online-only Data Supplement). Twenty-four–hour Holter ECG showed sinus rhythm except for mealtime. Tachyarrhythmia with warm-up phenomenon recurrently occurred during eating (Figure 3). The fluoroscopic swallowing study showed that tachycardia did not occur when swallowing only barium (Figure 4, Movie II in the online-only Data Supplement). When solid food (banana) was added, atrial tachyarrhythmia appeared as the bolus passed down behind the posterior wall of the left atrium (Figure 5, Movie III in the online-only Data Supplement). Because tachyarrhythmia occurred when swallowing solid but not liquid food, we advised her about the method of taking a meal such as to eat liquid foods or to eat chopped foods. After this instruction, atrial tachyarrhythmia and presyncope episodes did not recur.Download figureDownload PowerPointFigure 1. Resting 12-lead ECG showed sinus rhythm and no abnormality.Download figureDownload PowerPointFigure 2. Transthoracic echocardiography revealed normal left ventricular function and no structural heart disease. A, Parasternal long axis view, diastolic phase. B, Parasternal long-axis view, systolic phase. C, Four chamber view, diastolic phase. D, Four-chamber view, systolic phase.Download figureDownload PowerPointFigure 3. Twenty-four–hour Holter ECG: heart rate trend graph. Tachyarrhythmia recurrently occurred during eating (red arrow=mealtime).Download figureDownload PowerPointFigure 4. Fluoroscopic swallowing study. Tachycardia did not occur when swallowing only barium.Download figureDownload PowerPointFigure 5. Fluoroscopic swallowing study. Atrial tachyarrhythmia appeared (red arrow) as the bolus passed down behind the posterior wall of the left atrium when solid food (banana) was added.Swallowing-induced tachyarrhythmia is rare. Fewer than 50 cases have been reported.1 Most cases of swallowing syncope are associated with bradycardia.2 The majority of cases of swallowing-induced tachyarrhythmia occur in men aged >35 years and recur frequently a short time after swallowing.3 The mechanism of swallowing-induced tachyarrhythmia is known to be abnormal automaticity, reentrant tachycardia, and triggered activity. In this case, although it is difficult to verify the mechanism of the tachyarrhythmia, the activation of the sympathetic nervous system as ganglionated plexi caused by a mechanical stimulus to the posterior wall of the left atrium may act as the trigger.4DisclosuresNone.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.114.010235/-/DC1.Correspondence to Kazuyuki Tanoue, MD, 2nd Division of Cardiovascular Medicine, National Hospital Organization, Kagoshima Medical Center, 8-1 Shiroyama-chou, Kagoshima City, Kagoshima, 892-0853, Japan. E-mail [email protected]References1. Tandeter H, Kobal S, Katz A. Swallowing-induced atrial tachyarrhythmia triggered by salbutamol: case report and review of the literature.Clin Cardiol. 2010; 33:E116–E120.CrossrefMedlineGoogle Scholar2. Gordon J, Saleem SM, Ngaage DL, Thorpe JA. Swallow syncope associated with paroxysmal atrial fibrillation.Eur J Cardiothorac Surg. 2002; 21:587–590.CrossrefMedlineGoogle Scholar3. Tada H, Kaseno K, Kubota S, Naito S, Yokokawa M, Hiramatsu S, Goto K, Nogami A, Oshima S, Taniguchi K. Swallowing-induced atrial tachyarrhythmias: prevalence, characteristics, and the results of the radiofrequency catheter ablation.Pacing Clin Electrophysiol. 2007; 30:1224–1232.CrossrefMedlineGoogle Scholar4. Nakagawa H, Scherlag BJ, Patterson E, Ikeda A, Lockwood D, Jackman WM. Pathophysiologic basis of autonomic ganglionated plexus ablation in patients with atrial fibrillation.Heart Rhythm. 2009; 6(12 suppl):S26–S34.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Burke P, Carter S, Knapman F, Patti J, Butlin M, Gandevia S, Butler J, Eckert D and Bilston L (2020) Nocturnal swallowing augments arousal intensity and arousal tachycardia, Proceedings of the National Academy of Sciences, 10.1073/pnas.1907393117, 117:15, (8624-8632), Online publication date: 14-Apr-2020. Gomes L, da Silva R, Pedroni C, Garner D, Raimundo R and Valenti V (2020) Effects of effortful swallowing on cardiac autonomic control in individuals with neurogenic dysphagia: a prospective observational analytical study, Scientific Reports, 10.1038/s41598-020-67903-9, 10:1, Online publication date: 1-Dec-2020. Yildiz M and Doma S (2017) Effect of spontaneous saliva swallowing on short-term heart rate variability (HRV) and reliability of HRV analysis, Clinical Physiology and Functional Imaging, 10.1111/cpf.12475, 38:4, (710-717), Online publication date: 1-Jul-2018. Patel N, Ibrahim S, Shah J, Orellana-Barrios M, Paterick T and Tajik A (2017) Deglutition Syncope, Baylor University Medical Center Proceedings, 10.1080/08998280.2017.11929619, 30:3, (293-294), Online publication date: 1-Jul-2017. Gomes L, Silva R, Melo M, Silva N, Vanderlei F, Garner D, de Abreu L and Valenti V (2015) Effects of Effortful Swallow on Cardiac Autonomic Regulation, Dysphagia, 10.1007/s00455-015-9676-4, 31:2, (188-194), Online publication date: 1-Apr-2016. Gesualdo M, Scicchitano P, Carbonara S, Ricci G, Principi M, Ierardi E, Di Leo A, Cortese F and Ciccone M (2016) The association between cardiac and gastrointestinal disorders, Journal of Cardiovascular Medicine, 10.2459/JCM.0000000000000351, 17:5, (330-338), Online publication date: 1-May-2016. September 23, 2014Vol 130, Issue 13 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.114.010235PMID: 25245849 Originally publishedSeptember 23, 2014 PDF download Advertisement SubjectsElectrocardiology (ECG)Electrophysiology
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