{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T10:29:59Z","timestamp":1762770599464,"version":"build-2065373602"},"reference-count":13,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,10,27]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:p>We present a rare case of deglutition syncope in a woman in her 20s, who presented with a ten-year history of presyncope and visual disturbances triggered by eating.<\/jats:p>\n                  <jats:p>Investigations, including a resting 12-lead ECG and ambulatory Holter monitoring, revealed first-degree heart block and reproducible, high-grade atrio-ventricular (AV) block with ventricular asystole during eating, which was abolished by intravenous atropine, confirming a vagally mediated process.<\/jats:p>\n                  <jats:p>The diagnosis of deglutition syncope was established based on the strong temporal relationship with food intake and the observed cardioinhibitory response. No underlying gastrointestinal pathology was identified in our patient.<\/jats:p>\n                  <jats:p>Conservative management was initially preferred; however, the patient became more symptomatic, prompting dual-chamber pacemaker implantation, which resulted in complete resolution of her condition.<\/jats:p>\n                  <jats:p>This case highlights the importance of detailed history-taking and provocation testing in diagnosing deglutition syncope and explores established and emerging treatments such as pacemaker implantation and cardioneuroablation.<\/jats:p>","DOI":"10.1136\/bcr-2025-266815","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T10:25:15Z","timestamp":1762770315000},"page":"e266815","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Deglutition syncope: a rare cause of reflex syncope"],"prefix":"10.1136","volume":"18","author":[{"given":"Otto","family":"Fenske","sequence":"first","affiliation":[{"name":"Undergraduate Education Department, Epsom and Saint Helier University Hospitals NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John P","family":"Foran","sequence":"additional","affiliation":[{"name":"Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salma","family":"Nowell","sequence":"additional","affiliation":[{"name":"Cardiology, Guy's and St Thomas\u2019 NHS Foundation Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Gilchrist","sequence":"additional","affiliation":[{"name":"City St George\u2019s, University of London, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"2025111002250721000_18.11.e266815.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy037"},{"key":"2025111002250721000_18.11.e266815.2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy071"},{"key":"2025111002250721000_18.11.e266815.3","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euad163","article-title":"Twenty-five years of research on syncope","volume":"25","author":"Fedorowski","year":"2023","journal-title":"Europace"},{"key":"2025111002250721000_18.11.e266815.4","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1186\/s12872-019-1174-4","article-title":"Swallow syncope: a case report and review of literature","volume":"19","author":"Siew","year":"2019","journal-title":"BMC Cardiovasc Disord"},{"key":"2025111002250721000_18.11.e266815.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00399-012-0240-8"},{"key":"2025111002250721000_18.11.e266815.6","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1111\/pace.13559","article-title":"Reduced quality of life and greater psychological distress in vasovagal syncope patients compared to healthy individuals","volume":"42","author":"Ng","year":"2019","journal-title":"Pacing Clin Electrophysiol"},{"key":"2025111002250721000_18.11.e266815.7","doi-asserted-by":"publisher","DOI":"10.3121\/cmr.2010.969"},{"key":"2025111002250721000_18.11.e266815.8","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1080\/13696998.2019.1652186","article-title":"Pacemaker complications and costs: a nationwide economic study","volume":"22","author":"Cl\u00e9menty","year":"2019","journal-title":"J Med 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(APHRS) and the Latin American Heart Rhythm Society (LAHRS)","volume":"26","author":"Aksu","year":"2024","journal-title":"Europace"},{"key":"2025111002250721000_18.11.e266815.12","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1093\/europace\/euaa060","article-title":"Cardioneuroablation for the treatment of recurrent swallow syncope","volume":"22","author":"\u0160tiavnick\u00fd","year":"2020","journal-title":"Europace"},{"key":"2025111002250721000_18.11.e266815.13","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.hrcr.2023.04.022","article-title":"Selective cardioneuroablation of the posteromedial left ganglionated plexus for drug-resistant swallow syncope with functional atrioventricular block","volume":"9","author":"Yoneda","year":"2023","journal-title":"HeartRhythm Case Rep"}],"container-title":["BMJ Case 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