Transesophageal pacing

Transesophageal atrial pacing electrodes are quick, simple, and safe to use. A standard bipolar ventricular wire with an esophageal stethoscope, or a specially developed 'pill' or balloon electrode can be used. If advanced distally, these can also pace the ventricle.

The electrode is inserted to a depth of more than 40 cm and then withdrawn until a maximum atrial electrogram is recorded. Precise positioning is unnecessary, with pacing possible over a 10-cm range. Thresholds may be up to 10 mA.

Transesophageal atrial pacing can be used, like any other atrial electrode, to pace or sense. It can be used to treat atrial arrhythmias by burst pacing. In atrial flutter, pacing at rates 40 per cent higher than the flutter rate may restore sinus rhythm in over 50 per cent of patients. Success is increased by prior digitalization. Transesophageal atrial pacing is also used to diagnose tachyarrhythmias or to treat ventricular tachycardia, with success rates of up to 70 per cent at lower ventricular rates.

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