Deglutition syncope: a rare cause of reflex syncope

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.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.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.Conservative management was initially preferred; however, the patient became more symptomatic, prompting dual-chamber pacemaker implantation, which resulted in complete resolution of her condition.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.