Prolonged sinus pause following ingestion of a button battery

Para-esophageal inflammation secondary to button battery ingestion may rarely irritate the vagus nerve causing prolonged sinus pauses. We report such a case in a two-year-old who presented with prolonged sinus pauses noted on telemetry following button battery ingestion. A comprehensive evaluation deemed hyper-stimulation of the parasympathetic input to the sinus node as the possible etiology. This was determined to be most likely due to irritation and excessive stimulation of the vagus nerve secondary to para-esophageal inflammation. Because of the underlying mechanism of the sinus pauses, treatment with anti-cholinergic/anti-inflammatory agents was pursued with significant improvement in the clinical presentation. The case highlights the need to delineate the mechanism of sinus pauses in patients, as it may be reversible. Treatment directed at the underlying etiology is indicated to prevent inappropriate consideration/placement of a permanent pacemaker and avoid its associated co-morbidities, especially in the pediatric population.