Cardio Command

Optimal Positioning of Electrodes for Transesophageal Atrial Pacing

The stimulus current required for successful atrial capture varies in proportion to the distance between the esophageal electrodes and the atrial myocardium. Minimizing this distance is critical for minimizing both stimulus current and any discomfort (generally described as heartburn) which may be experienced by conscious patients. Our recommendations for catheter insertion are as follows:

Using patient's height: Depth of insertion (DOI, cm) within the esophagus is printed on CardioCommand catheters. For oral insertion, the optimal range of DOI for atrial pacing can be estimated using patient height: DOI = height (cm) / 5, or height (ins) / 2.  An additional 3 to 4 cm DOI should be used for nasal insertions. For most patients, atrial capture can be achieved within a range of +/- 3 cm about this DOI. For infants and children, it is recommended that electrodes be positioned with monitoring of the esophageal ECG.  Abstract

Using ECG tracings: Insert electrodes to an initial DOI = height/5 + 5 (for nasal: height/5 + 9 ) cm. While monitoring esophageal electrocardiogram, gradually withdraw catheter to the DOI which maximizes amplitude of the ECG P-wave (see below). Abstract