Cilostazol for Probable Swallow Syncope Associated With Sick Sinus Syndrome in a Nonagenarian Receiving Home-Based Care: A Case Report.

BACKGROUND

Swallow syncope is a rare reflex syncope, typically treated with pacemaker implantation. Pharmacological alternatives may be considered when pacemaker implantation is not feasible or not concordant with goals of care.

CASE PRESENTATION: We report a nonagenarian woman with dementia, very severe aortic stenosis, heart failure, and sick sinus syndrome who developed recurrent meal-triggered syncope after discharge. Holter monitoring documented multiple prolonged sinus pauses during hospitalization. Given frailty, comorbidities, and the family's preference to avoid rehospitalization, pacemaker implantation was not pursued. Cilostazol 100 mg twice daily was initiated in home-based care, resulting in complete resolution of syncope over 10 months without adverse effects.

CONCLUSION

Cilostazol may represent a noninvasive therapeutic option for carefully selected patients with probable swallow syncope when pacemaker implantation is not concordant with goals of care.