Abstract
Background and hypothesis: Transesophageal atrial pacing (TAP) is useful for terminating paroxysmal non‐selfterminating atrial flutter (RAF); however, high output pacing of long stimulus duration causes severe symptoms such as chest pain. The objective of this study was to investigate the effect of low‐output, short‐duration TAP on the conversion of PAF.
Methods: We applied low‐output (within 15 mA with a pulse duration of 10 ms), short‐duration (within 4 s) TAP in 31 patients (50±19 years) with PAF. Transesophageal pacing was delivered with 10 pulses of burst pacing at intervals that were 20 ms shorter than those of the flutter wave length. When the conversion was unsuccessful, we delivered 20 pulses of burst pacing.
Results: Sixteen patients (52%) were converted directly to sinus rhythm and 12 (38%) to atrial fibrillation. Transesophageal pacing was ineffective in 3 (10%) patients. The duration of atrial flutter, maximum flutter wave amplitude, effective pacing intervals, underlying heart diseases, and cardiac function were not different between patients who had direct conversion to sinus rhythm and those converted to atrial fibrillation. The patients who had direct conversion to sinus rhythm had longer flutter wave cycle lengths than those converted to atrial fibrillation (248 vs. 221 ms, p<0.005). No patient had complications and complained of any symptoms.
Conclusion: Low‐output, short‐duration TAP was useful to convert PAF directly to sinus rhythm without side effects.
Keywords: pacing, atrial flutter, conversion
Full Text
The Full Text of this article is available as a PDF (556.0 KB).
References
- 1. Falk RH, Werner M: Transesophageal atrial pacing using a pill electrode for the termination of atrial flutter. Chest 1987; 92: 110–114 [DOI] [PubMed] [Google Scholar]
- 2. Montoy JV, Angel J, Valle V, Gausi C: Cardioversion of tachycardias by transesophageal atrial pacing. Am J Cardiol 1973; 32: 85–90 [DOI] [PubMed] [Google Scholar]
- 3. Crawford W, Plumb VJ, Epstein AE, Kay GN: Prospective evaluation of transesophageal pacing for the interruption of atrial flutter. Am J Med 1989; 86: 663–667 [DOI] [PubMed] [Google Scholar]
- 4. Guarnerio M, Furlanello F, Del Greco M, Vergara G, Inama G, Disertori M: Transesophageal atrial pacing: A first‐choice technique in atrial flutter therapy. Am Heart J 1989; 117: 1241–1252 [DOI] [PubMed] [Google Scholar]
- 5. Kantharia BK, Mookherjee S: Clinical utility and the predictors of outcome of overdrive transesophageal atrial pacing in the treatment ofatrial flutter. Am J Cardiol 1995; 76: 144–147 [DOI] [PubMed] [Google Scholar]
- 6. Castellanos A Jr, Lemberg L, Gosselin A, Fonseca EJ: Evaluation of countershock treatment of atrial flutter. Arch Intern Med 1965; 115: 426–433 [DOI] [PubMed] [Google Scholar]
- 7. Lown B: Electrical reversion of cardiac arrhythmias. Br Heart J 1967; 29: 469–489 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Morris JJ Jr, Kong Y, North WC, McIntosh HD: Experience with “cardioversion” of atrial fibrillation and flutter. Am J Cardiol 1964; 14: 94–100 [DOI] [PubMed] [Google Scholar]
- 9. Wells JL Jr, MacLean WAH, James TN, Waldo AL: Characterization of atrial flutter. Studies in man after open heart surgery using fixed atrial electrodes. Circulation 1979; 60: 665–673 [DOI] [PubMed] [Google Scholar]
- 10. Inoue H, Yamashita T, Nozaki A, Sugimoto T: Effects of antiarrhythmic drugs on canine atrial flutter due to reentry: Role of prolongation of refractory period and depression of conduction to excitable gap. J Am Coll Cardiol 1991; 18: 1098–1104 [DOI] [PubMed] [Google Scholar]
- 11. Spinelli W, Hoffman BF: Mechanisms of termination of reentrant atrial arrhythmias by class I and class III antiarrhythmic agents. Circ Res 1989; 65: 1565–1579 [DOI] [PubMed] [Google Scholar]
- 12. Peters RW, Weiss DN, Carliner NH, Feliciano Z, Shorofsky SR, Gold MR: Overdrive pacing for atrial flutter. Am J Cardiol 1994; 74: 1021–1023 [DOI] [PubMed] [Google Scholar]
- 13. Greenberg ML, Kelly TA, Lerman BB, Dimarco JP: Atrial pacing for conversion of atrial flutter. Am J Cardiol 1986; 58: 95–99 [DOI] [PubMed] [Google Scholar]
- 14. Han J, Millet D, Chizzonitti B, Moe GK: Temporal dispersion of recovery of excitability in atrium and ventricle as a function of heart rate. Am Heart J 1966; 71: 481–487 [DOI] [PubMed] [Google Scholar]
- 15. Allessie MA, Bonke FIM, Schopman FJG: Circus movement in rabbit atrial muscle as a mechanism of tachycardia. III. The “leading circle” concept: A new model of circus movement in cardiac tissue without the involvement of an anatomical obstacle. Circ Res 1977; 41: 9–18 [DOI] [PubMed] [Google Scholar]
- 16. Allessie MA, Lammers WJEP, Bonke IM, Hollen J: Intra‐atrial reentry as a mechanism for atrial flutter induced by acetylcholine and rapid pacing in the dog. Circulation 1984; 70: 123–135 [DOI] [PubMed] [Google Scholar]
- 17. Disertori M, Inama G, Vergara G, Guarnerio M, Del Favero A, Furlanello F: Evidence of a reentry circuit in the common type of atrial flutter in man. Circulation 1983; 67: 434–440 [DOI] [PubMed] [Google Scholar]
- 18. Olshansky B, Okumura K, Hess PG, Waldo AL: Demonstration of an area of slow conduction in human atrial flutter. J Am Coll Cardiol 1990; 16: 1639–1648 [DOI] [PubMed] [Google Scholar]