We describe a rare and severe presentation of deglutition syncope, manifesting as complete heart block, along with newer therapeutic options, including cardioneural ablation and leadless pacing. Our 15-year-old patient presented with frequent syncope with swallowing, along with symptoms of orthostatic intolerance and anxiety. When standard non-pharmacologic and pharmacologic treatments were insufficient, cardioneural ablation resulted in improvement in syncope. Subsequent standard treatment of orthostatic intolerance has significantly improved the quality of life, including allowing her a more normal diet. The option of leadless pacing to prevent bradycardia during episodes of induced heart block has not yet been enacted due to her clinical improvement.
