creators_name: Verbeet, Thierry
creators_name: Castro, José
creators_name: Decoodt, Pierre
editors_name: Singh, Balbir
editors_name: Lokhandwala, Yash
editors_name: Francis, Johnson
editors_name: Gupta, Anup
type: journalp
datestamp: 2005-04-20
lastmod: 2011-03-11 08:55:58
metadata_visibility: show
title: Transesophageal pacing : a versatile diagnostic and therapeutic tool
ispublished: pub
subjects: ipej
full_text_status: public
keywords: transesophageal pacing, esophageal pacing, atrial pacing, supraventricular arrhythmias
abstract: Transesophageal atrial pacing is feasible because of the proximity between the oesophagus and the posterior aspect of the atria1. Atrial pacing is possible through the oesophagus in almost all patients and can yield important information in many arrhythmias where single site atrial pacing is of value. It is a cheap procedure. There is no need for X Rays or cathlab.

Technical considerations

            Transesophageal pacing and recording is done using specialized or non specialized catheters. There are two different lead types: 1) the pill electrode, connected to a flexible wire, that the patient swallows with water. This pill electrode necessitates patient collaboration. 2) a flexible catheter that can even be used in comatose or intubated patients.

            The pacing lead, in our cases a bipolar flexible catheter, is introduced into the oesophagus via the nares after local nose anesthesia with xylocaine spray. Sometimes throat anesthesia with the same spray is also performed. Xylocaine gel is used to lubricate the lead and the lead is introduced with guidewires in it in order to increase its stiffness. It is positioned into the oesophagus in order to record the posterior paraseptal atrial electrogram. There is a relationship between the site of maximal atrial amplitude and the lowest atrial pacing threshold. The optimal atrial pacing site is usually found around 40 cm from the nares. Bipolar or unipolar recordings can be made.

date: 2003-10
date_type: published
publication: Indian Pacing and Electrophysiology Journal
volume: 3
number: 4
publisher: Indian Pacing and Electrophysiology Group
pagerange: 202-209
refereed: TRUE
referencetext: 1. Prystowsky EN, Pritchett ELC, Gallagher JJ: Origin of the atrial electrogram recorded from the esophagus. Circulation 61:1017-1023, 1980.

2. Benson DW, Sanford M, Dunnigan A, et al.: Transesophageal atrial pacing threshold: role of interelectrode spacing, pulse width, and catheter insertion depth. Am J Cardiol 53:63-67, 1984.

3. Hammill SC, Pritchett ELC: Simplified esophageal electrocardiography using bipolar recording, leads. Ann Intern Med 95:14-18, 1981

4. Gallagher JJ, Smith WM, Kerr, CR, et al.: Esophageal pacing: a diagnostic and therapeutic tool. Circulation 65:336-341, 1982.

5. Critelli G, Grassi G, Perticone F, et al.: Transesophageal pacing for prognostic evaluation of preexcitation syndrome and assessment of protective therapy. Am J Cardiol 5 1:513-518, 1983.

6.  Gallagher JJ, Smith WM, Kasell J, et al.: The use of the esophageal lead in the diagnosis of mechanisms of reciprocating supraventricular tachycardia. PACE 3:440-451, 1980.

7. Falk RH, Werner M: Transesophageal atrial pacing using a pill electrode for the termination of atrial flutter. Chest 92:110-114, 1987.

8. Benson DW, Dunnigan A, Sterba R, et al.: Atrial pacing from the esophagus in the diagnosis and management of tachycardia and palpitations. J Pediatr 102:40-46,1983.

9.  Burack B, Furman S: Transesophageal cardiac pacing. Am J Cardiol 23:469472, 1969.

10.  Lubell DL: Cardiac pacing from the esophagus. Am J Cardiol 27:641-644, 1971.

11. Brunetto JF, Sgammini HO, Ledesma RE, et al.: Evaluation of sinoatrial node function through the use of transesophageal atrial pacing (Abstract). PACE 2:9, 1979.

12.  Verbeet T, Castro J , Morissens M, El Khoury S, Blankoff I : Transesophageal pacing, a useful tool in the management of arrhythmias. Archives des Maladies du Coeur et des Vaisseaux: 91 III,294, 1978 (abstract)
citation:   Verbeet, Thierry and Castro, José and Decoodt, Pierre  (2003) Transesophageal pacing : a versatile diagnostic and therapeutic tool.  [Journal (Paginated)]     
document_url: http://cogprints.org/4245/1/verbeet.htm