PMC3891415_01
(A) Holter monitoring immediately following the ingestion of a cup of beer (Case 1). The patient had a 7.2-second sinus pause. (B) Electrocardiogram monitoring of the challenge test with a carbonated beverage (a soda pop). The sinus bradycardia caused by the first sip of a soda pop turned into a sinus arrest for 5.4 seconds after the second sip.
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F1
Holter monitoring showed a sinus arrest with a maximum 7.2 seconds pause while drinking beer and a carbonated beverage (Figure 1A, 1B).
(A) A basal electrocardiography shows normal sinus rhythm (75 beats per minutes) in case 1. B. Esophageal balloon inflation at the lower esophagus initiated marked sinus bradycardia (33 beats per minutes) that could not be induced at the middle and upper esophagus.
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F2
After backing up the permanent pacemaker, esophageal balloon inflation by a Sengstaken-Blakemore tube with the pressure of 40 mmHg at the lower esophagus induced marked sinus bradycardia (Figure 2).
PMC3891415_02
(A) Esophageal balloon inflation at the T7 level of the esophagus made a sinus pause (3.08 seconds) and marked bradycardia. (Case 2) B. Esophageal balloon inflation at the T9 level of the esophagus initiated a junctional rhythm. C. Esophageal balloon inflation at the T9 level of the esophagus after atropine 1mg IV blocked the reflex.. T: thoracic vertebra
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F3
Inflation of the balloon in the lower esophagus and gastroesophageal junction that was at the 9th thoracic spine level resulted in junctional rhythm (32~36 beats per minutes) with lightheadedness (Figure 3, Figure 4). However, an atropine pretreatment blocked this response (Figure 3C).
Esophageal balloon inflation done under fluoroscopy. White hollow arrows indicate an esophageal balloon inflated at the lower esophagus (9th thoracic vertebra level in case 2). Black arrows indicate the margin of air shadow in the stomach.
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F4
Inflation of the balloon in the lower esophagus and gastroesophageal junction that was at the 9th thoracic spine level resulted in junctional rhythm (32~36 beats per minutes) with lightheadedness (Figure 3, Figure 4).