Transesophageal Pacing for Temporary Heart Rate Acceleration and Management of Hemodynamics

Transesophageal atrial pacing for treatment of acute sinus bradycardia.

Iliou MC, Lavergne T, Bendada A, LeHeuzey JY, Guize L. RBM 16(3/4): 138-141, 1994. Transesophageal atrial pacing (TAP) is a non-invasive technique commonly used for reduction of supraventricular tachycardias. Few cases of long-term TAP have been reported in patients with general anesthesia. The present study was conducted for assessing the feasibility and tolerance of long-term TAP in non-sedated patients. Ten symptomatic patients (mean age 71.4 years, range 58-87) with sinus bradycardia were paced in esophagus using a 20-25 ms duration pulse with voltage ranging from 12-20 V at a rate > 60 BPM. No patient had significant impairment of anterograde AV conduction. Sinus bradycardia was caused by drugs in 8 and/or hyperkalemia in 2 patients. TAP was maintained until sinus rate exceeded pacing rate during mean time of 22.8 hours (1.5 - 98 hrs). Four patients had permament pacemaker implanted. Esophageal fibroscopy was performed in 4 patients; no lesions were found. Tolerance was assessed using an auto-evaluation scale. Two patients were asymptomatic, 5 had a slight discomfort, and 3 had moderate chest pain which did not require interruption of TAP. Alteration of the anodal electrode was noted when TAP exceeded 24 hours. In conclusion, TAP is an efficient and safe technique for prolonged atrial pacing in non-sedated patients with transient symptomatic sinus bradycardia.

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