• Research & Clinical Studies

    Transesophageal Electrophysiology: Diagnosis and Treatment of Atrial Arrhythmias



    Cardioversion and Defibrillation:

    Below: Example of cardioversion of atrial flutter using transesophageal burst pacing.
    Transient atrial fibrillation occurs before conversion to sinus rhythm. Esophageal ECG (Esoph)
    provides superior documentation of atrial arrhythmias as compared to surface leads (I,II,III).

    "Esophageal pacing is an effective, well tolerated method of initiating atrial fibrillation and flutter and terminating atrial flutter and offers a potentially useful noninvasive method of following patients serially." Kerr CR, et al. PACE 6(1 Pt 1): 60-72, 1983. Abstract

    "Because the success rates are comparable with invasive technique and the procedure is simpler, the noninvasive transesophageal anti-tachycardia pacing should be respected as the method of the first choice in patients with supraventricular tachycardias." Volkmann H, et al. PACE 15(11 Pt 2):1962-6, 1992. Abstract

    "We recommend a trial of transesophageal atrial pacing for acute conversion of any episode of atrial flutter in children prior to direct current cardioversion." Campbell RM, MacDonald D, Jenkins JM. Pediatrics 75(4):730-6, 1985. Abstract

    "Transesophageal cardioversion decreased the defibrillation threshold three-to-fourfold from that of conventional transthoracic cardioversion. There were no complications of heart block, ventricular fibrillation, or any pathologic evidence of esophageal injury. Thus transesophageal low-energy synchronous cardioversion is considered a feasible and effective method for the treatment of atrial flutter/fibrillation." Yamanouchi Y, et al. Am Heart J 123(2):417-20, 1992. Abstract

    "Transesophageal atrial pacing is a safe and effective means of terminating atrial flutter in the pediatric population. It is minimally invasive, it can often be performed in an outpatient setting, and the technique may occasionally be facilitated by infusion of intravenous procainamide."     Rhodes LA, et al. Am Heart J 130(2):323-7, 1995. Abstract

    "The results of our study suggest that atrial pacing from the esophagus is the method of choice in the treatment of paroxysmal supraventricular tachycardias and perhaps of nonparoxysmal A-V junctional tachycardias in digitalized patients who require rapid suppression of the arrhythmia." Montoyo JV, et al. Am J Cardiol 32(1):85-90, 1973. Abstract

    "Transesophageal atria pacing using a pill electrode was performed in 49 patients with atrial flutter ... Normal sinus rhythm could be resumed in most patients with atrial flutter by TAP. It does not require general anesthesia and can be performed even in patients who have undergone digitalization, when a direct-current countershock may be of some concern." Kantharia BK, Mookherjee S. Am J Cardiol 76(3) p144-7, 1995. Abstract



    Diagnosis of Arrhythmias and Reentry Conduction Pathways:

    "Esophageal stimulation and recording provides a simple noninvasive procedure which can be utilized as a screening technique to identify patients with intranodal reentry and those with reentry utilizing an accessory pathway. Sequential assessment of the response to therapy, especially in those patients with pre-excitation, is of considerable value in treatment." Harte MT,et al. Chest 93(2):339-44, 1988. Abstract

    "There were no differences between parameters obtained by intracardiac vs. transesophageal atrial stimulation. These results, and the already documented ability of TAP to induce atrial fibrillation, suggest this noninvasive technique should be taken as a first approach in screening patients with Wolff-Parkinson-White (WPW) syndrome." Favale S, et al. Int J Cardiol 30(2):209-14, 1991. Abstract

    "Esophageal pacing is overall useful to diagnose undocumented paroxysmal tachycardia fits, evaluate the refractory stages of an accessory pathway (WPW) or of antiarrhythmia medications. This investigation may also be used to assess sinus function, AV conduction (Wenckebach point) and spontaneous rhythm of AV blocks after pacemaker insertion. Due to technical improvements, esophageal pacing may be used presently in pediatric units taking care of children with arrhythmias." Lucet V, et al. Arch Fr Pediatr 47(3):185-9, 1990. Abstract



    Evaluating Atrial Vulnerability and  Antiarrhythmia Therapy:

    "53.5% of the patients who are "non responders" to the electropharmacological test with one of the two drugs (propafenone or flecainide) may be "responders" to the other drug. Thus the ineffectiveness of one of the two drugs is not predictive of ineffectiveness of the other." Inama G, et al. G Ital Cardiol 21(2):131-8, 1991. Abstract

    "Noninvasive transesophageal pacing is an appropriate method for evaluation of SVT. It allows serial drug testing in a simple manner for finding an effective antiarrhythmic treatment." Volkmann H, et al. PACE 13(12 Pt 2):2044-7, 1990. Abstract

    "The sensitivity of TAP in predicting the outcome of the patients with narrow QRS complex tachycardia (NQT) was 90% and the specificity 89%. The negative predictive value of TAP (prediction of no recurrence of NQT) was 96%, and the positive predictive value (prediction of recurrence of NQT) was 75%. We conclude that TAP is a simple and accurate method for predicting the efficacy of antiarrhythmic treatment in patients with NQT." Kulakowski P, et al. PACE 15(6):895-904,1992. Abstract