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Peer-reviewedCC BY-NC-ND 4.0JACC Case Reports

Selective Cardioneuroablation for Swallow-Induced Atrioventricular Block

  • Katsuhide Hayashi1
  • Ritsuko Kohno2
  • Masashi Mitani1
  • Takahiro Kobayashi1
  • Nozomu Ishii1
  • Yasunobu Yamagishi1
  • Yasushi Oginosawa2
  • Haruhiko Abe2
  • Masaharu Kataoka1
  1. 1Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
  2. 2Heart Rhythm Management, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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Abstract

Background: Swallow-induced atrioventricular (AV) block is a rare mechanism of paroxysmal AV block, and no established curative treatment currently exists.

Case Summary: A 75-year-old woman without known structural heart disease presented with symptomatic paroxysmal AV block during meals. Swallowing provocation test reproducibly induced AV block at the A-H level, which was suppressed following atropine administration, suggesting a vagally mediated reflex mechanism. Despite dietary counseling, her symptoms persisted; therefore, cardioneuroablation (CNA) was performed. Among the ganglionated plexi, sites demonstrating vagal responses during high-frequency stimulation, as well as anatomically defined ganglionated plexi regions, were selectively ablated. Following the procedure, no further swallow-induced paroxysmal AV block was observed.

Discussion: In this case, combined selective and anatomical CNA approach was used, targeting sites considered to provide parasympathetic input to the AV node.

Take-Home Message: Mechanism-based selective CNA may represent a promising therapeutic option for patients with swallow-induced AV block refractory to conservative management.

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Cite

BibTeXRIS
BibTeX
@article{hayashi2026selective,
  title = {{Selective Cardioneuroablation for Swallow-Induced Atrioventricular Block}},
  author = {Katsuhide Hayashi and Ritsuko Kohno and Masashi Mitani and Takahiro Kobayashi and Nozomu Ishii and Yasunobu Yamagishi and Yasushi Oginosawa and Haruhiko Abe and Masaharu Kataoka},
  journal = {JACC Case Reports},
  year = {2026},
  month = aug,
  doi = {10.1016/j.jaccas.2026.109917},
  url = {https://doi.org/10.1016/j.jaccas.2026.109917},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Selective Cardioneuroablation for Swallow-Induced Atrioventricular Block
AU  - Katsuhide Hayashi
AU  - Ritsuko Kohno
AU  - Masashi Mitani
AU  - Takahiro Kobayashi
AU  - Nozomu Ishii
AU  - Yasunobu Yamagishi
AU  - Yasushi Oginosawa
AU  - Haruhiko Abe
AU  - Masaharu Kataoka
PY  - 2026
DA  - 2026/08/25
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.109917
UR  - https://doi.org/10.1016/j.jaccas.2026.109917
AB  - Background: Swallow-induced atrioventricular (AV) block is a rare mechanism of paroxysmal AV block, and no established curative treatment currently exists.  Case Summary: A 75-year-old woman without known structural heart disease presented with symptomatic paroxysmal AV block during meals. Swallowing provocation test reproducibly induced AV block at the A-H level, which was suppressed following atropine administration, suggesting a vagally mediated reflex mechanism. Despite dietary counseling, her symptoms persisted; therefore, cardioneuroablation (CNA) was performed. Among the ganglionated plexi, sites demonstrating vagal responses during high-frequency stimulation, as well as anatomically defined ganglionated plexi regions, were selectively ablated. Following the procedure, no further swallow-induced paroxysmal AV block was observed.  Discussion: In this case, combined selective and anatomical CNA approach was used, targeting sites considered to provide parasympathetic input to the AV node.  Take-Home Message: Mechanism-based selective CNA may represent a promising therapeutic option for patients with swallow-induced AV block refractory to conservative management.
SN  - 2666-0849
ER  -