ArticleJACC. Case reports2026
Swallowing Syncope With Atrial Fibrillation Treated by Wide Area Circumferential Ablation and Cardioneuroablation.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSwallowing 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.
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