Palpitations or afib after every swallow

Apparently the acronym for what I have is SIAT (swallowing induced atrial tachycardia). I had my first bout of this about 20 years ago. All the usual tests (echocardiogram, EKG, thyroid etc) all showed a normal heart. After several years of battling this I discovered I had acid reflux. They treated me with PPI medication and it seemed to eventually work. The past 15 years I was free of this nightmare. This fall it all returned with a vengeance. Now I find it difficult to eat enough because every time I swallow food, drink or dry, my heart goes into atrial arrhythmia and occasionally afib. It is very stressful. I have had 7 bouts of afib in the past month. I can't emphasize enough how the trigger is always the mechanical action of swallowing. If I don't swallow I am always in normal sinus rhythm. This is a living nightmare. I am losing weight because despite being hungry I have to stop eating due to the arrhythmia. I am being scheduled for an EP ablation but do not know when. It is probably worth noting that other than this ugly problem I am in perfect health. I have always been an endurance athlete also.

If you google SIAT you will see that it is very rare (only 50 documented cases to date worldwide). Lucky me. Does anyone have experience with this or a suggestion?? Thanks

Peter 56 years old.

11 Replies

  • Hi Peter! Afraid I've never heard of this . Looked it up and it does sound very strange ...and interesting! What a problem for you. I do hope that you don't have long to wait for your ablation.



  • Thanks Sandra. Yes this is a very spooky thing to be suffering from. I am so looking forward to the ablation. Even the doctors can't fully appreciate the living hell I find myself in. Take care

  • I trust you are aware of the association of af with endurance athletes. 3 of us in our club of 150 have it. All started in their mid 40s.

    Difficult to manage without swallowing but what about using an antiarythmic such as flecainide while awaiting ablation. Seems a bit quick to be going for that so soon! I'm a great fan of pill in the pocket and usually can abort an episode with just 50mg. As you know the more often you have af the more likely it is to recur, so it would be good to try and get control.

    I expect your chads score doesn't indicate anticoagulant at your age if you are low risk but doubtless it has been discussed.

  • Thanks for the reply. I was just prescribed flecainide 50 mg twice a day. I am hoping it will provide some control over the problem while I await the ablation. I have been dealing with this since 1995 when it first started. I was fortunate to have it go dormant for the past 15 years but it has Coe back hard. I realize the connection to endurance athletes. That is a tough one to swallow (please excuse the pun). All those years of dedicated long distance training actually coming back to haunt me. The good news is that it seems the swallowing induced atrial tachycardia, while being very rare, seems to respond very favourably to ablation.

    Thanks again

  • Yes it's an unfortunate fact that we have to face up to living with af for the future as we will always have an increased risk of it recurring.

  • Have you considered the ablation route? I just met with a top electrophysiologist that said they are having very good success with PVI (pulmonary vein isolation) ablation of afib. Seems that most afib events start from the atrial tissue where the pulmonary veins attach. They build an electric fence to stop the afib from happening. It seems my SIAT is a blessing and a curse in that if I can demonstrate it on the table, they can see where it is coming from and zap it.

  • Yes pvi is the next step for me, but I'm continuing with pill in the pocket at present.

    A friend (previously national level cyclist and triathlete ) who is a few years ahead of me has been going down the same route. He finished up with a total of 7 ablations before getting a pacemaker.

    It seems a journey and I now do much less sport.

  • Sorry to hear about your friend needing a pacemaker. Everything I have read indicates that the chances of success with ablation depend on the length of time you have been dealing with afib. Sadly it appears the atrial myocardium adapts to the afib (remodelling) making it more difficult to ablate. I want to try for an ablation soon for that reason. I wonder how many dedicated athletes such as those who compete internationally in events like the Tour de France, will ultimately face heart rhythm issues.

    If I am fortunate to get a second chance, I will definitely change my approach to exercise.

  • My friend was a British cycling champion and triathlete. He continues as an international referee for events. I think he was onto his af early as like me he has been using hr monitoring for many years

  • At what age did you and your friend first start experiencing problems with afib? And if you don't mind me asking what is the pill in the pocket dose you taken when afib starts?

  • Around 50 it started. Using 50mg flec usually does the trick

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