Swallowing Syncope With Atrial Fibrillation Treated by Wide Area Circumferential Ablation and Cardioneuroablation.

BACKGROUND

Swallowing syncope is a neurally mediated reflex syncope triggered by deglutition, often due to excessive vagal activation. Cardioneuroablation (CNA) is an emerging alternative to pacemaker therapy in selected cases.

CASE SUMMARY: A 75-year-old man with atrial fibrillation (AF) presented with recurrent swallowing-induced syncope. During esophagogastroduodenoscopy, he developed reproducible bradycardia, confirming a vagally mediated cardioinhibitory response. He underwent combined wide area circumferential ablation (WACA) and targeted CNA with radiofrequency ablation. After ablation, his symptoms resolved, with maintenance of sinus rhythm at 1 year. Heart rate variability analysis showed a marked reduction in SDNN (standard deviation of all normal-to-normal intervals) from 138.7 to 59.4 ms, indicating a parasympathetic withdrawal pattern.

DISCUSSION: This case highlights the successful management of swallowing syncope with concomitant AF using combined WACA and CNA with radiofrequency ablation-a novel, pacemaker-sparing therapeutic strategy.

TAKE-HOME MESSAGE: Combined WACA and CNA provide durable relief of vagally mediated swallowing syncope in patients with AF.