High-Resolution Esophageal Manometry with ECG Monitoring for Management of Premature Ventricular Complexes-Associated Dysphagia

We report a novel technique for diagnosing a new cause of esophageal dysphagia in a patient without organic heart and esophageal disease. A coincidence between intermittent esophageal dysphagia and cardiac arrhythmia, frequent premature ventricular complexes (PVC) were confirmed by clinical observation, simultaneous ECG monitoring, and motility study. High-resolution esophageal manometry (HRM) revealed abnormal peristaltic waves only during frequent PVC. Abnormal peristaltic waves and PVC disappeared simultaneously and completely within 15 min after intravenous infusion of antiarrhythmic agent (140 mg propafenone). Oral treatment with antiarrhythmic drugs was not tolerated or ineffective. Complete remission of PVC and dysphagia was achieved immediately after radiofrequency catheter ablation of arrhythmogenic focus located in the right ventricular outflow tract. This case demonstrates a new technique for the management of a syndrome called “PVC-associated dysphagia” that can be mediated by cardioesophageal reflex. Interdisciplinary cooperation and simultaneous HRM with ECG monitoring may confirm the diagnosis and guide effective treatment.