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. 2003 Oct 1;3(4):202-9.

Transesophageal pacing: a versatile diagnostic and therapeutic tool

Thierry Verbeet  1 , José Castro, Pierre Decoodt
Affiliations

Transesophageal pacing: a versatile diagnostic and therapeutic tool

Thierry Verbeet et al. Indian Pacing Electrophysiol J. .
No abstract available

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Figures

Figure 1
Figure 1
Medtronic 6992A lead
Figure 2
Figure 2
Esophageal electrograms in sinus rhythm (left), atrial flutter (center) and atrial fibrillation (right)
Figure 3
Figure 3
Evaluation of AV nodal Wenckebach point with esophageal pacing under betablocking therapy in a patient suffering of fast conducting atrial fibrillation
Figure 4
Figure 4
This patient complains of palpitations and has a short PR that could mask a delta wave. A single esophageal extrastimulus (right) captures the atrium, prolongs the atrioventricular conduction and does not demonstrate any preexcitation.
Figure 5
Figure 5
This patient presents with atrial fibrillation conducting along a left lateral accessory pathway (third set), although preexcitation is concealed on the sinus surface EKG due to rapid atrioventricular conduction and short PR (first two sets). Atrial pacing during the ablation session unmasks preexcitation (fourth set). This emphasizes the usefulness of atrial pacing in short PR accompanied by palpitations.
Figure 6
Figure 6
Assessment of initial slurring of the QRS complex. Preexcitation is excluded by esophageal pacing that demonstrates prolongation of atrioventricular nodal conduction without preexcitation.
Figure 7
Figure 7
Esophageal pacing triggers a reciprocating tachycardia with LBBB aberration in a patient with WPW disease.
Figure 8
Figure 8
Same patient: atrial fibrillation with fast conducting ventricular conduction occurs through the accessory pathways after an attempt to stop the reciprocating tachycardia with esophageal pacing. Induction of atrial fibrillation is also useful when an esophageal stimulus is not followed by a QRS complex and atrial capture is difficult to assess on the surface EKG.
Figure 9
Figure 9
Induction of atrial fibrillation with esophageal pacing in a patient with WPW disease. QRS complexes during atrial fibrillation are not preexcited demonstrating poor anterograde accessory pathway conduction.
Figure 10
Figure 10
Assessment of anterograde accessory pathway refractory period (in this case 320 msec) in a patient with WPW disease using transesophageal pacing.
Figure 11
Figure 11
Triggering of AV nodal reentrant tachycardia (above) in a patient with undocumented episodes of palpitations. The esophageal electrogram (middle) shows fused atria and ventricular electrograms. The surface EKG during tachycardia is also diagnostic (see above, pseudo S waves in D2). The tachycardia is stopped by one esophageal stimulus (below).
Figure 12
Figure 12
Triggering of reciprocating tachycardia with a single esophageal stimulus in a patient with undocumented palpitations
Figure 13
Figure 13
Interruption of typical atrial flutter with esophageal pacing
Figure 14
Figure 14
Inadvertent ventricular pacing occurs when the lead is pushed too deep in the oesophagus and high energies are used (PW: 20 ms, intensity 15 mA)
See this image and copyright information in PMC

References

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    1. Gallagher JJ, Smith WM, et al. Esophageal pacing: a diagnostic and therapeutic tool. Circulation. 1982;65:336–341. - PubMed
    1. Critelli G, Grassi G, Perticone F, et al. Transesophageal pacing for prognostic evaluation of preexcitation syndrome and assessment of protective therapy. Am J Cardiol. 1983;51:513–518. - PubMed

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