Atlee JL 3d; Pattison CZ; Mathews EL; Hedman AG. Medical College of Wisconsin. J Cardiothorac Vasc Anesth (United States), Aug 1993, 7(4) p436-41. Sinus bradycardia (SB) or atrioventricular junctional rhythm (AVJR) may produce circulatory insufficiency in anesthetized surgical patients, especially those with cardiovascular disease. Chronotropic drugs have been the preferred initial treatment, except when epicardial pacing is available. Alternative methods include transvenous or transcutaneous pacing. Drugs may be ineffective or have undesirable effects. Transvenous pacing is time consuming and risky, and transcutaneous pacing is not universally applicable or effective. Transesophageal atrial pacing (TAP) lacks these disadvantages, but unavailability of equipment and unfamiliarity with the method has discouraged widespread use. Feasibility of TAP as prophylaxis for intraoperative SB or AVJR was tested with approved or investigational devices in 200 anesthetized surgical patients, not necessarily with cardiovascular disease or having cardiac surgery. Of these, 84 later had incidental SB or = 60 beats/min, and 23 of these 84 had SB or = 50 beats/min. Thirteen patients had AVJR (72 +/- 4 beats/min; mean +/- SEM). TAP at 80 beats/min for SB, or at a rate sufficient to overdrive AVJR, was effective initial treatment in all patients.