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Cardioversion of tachycardias by transesophageal atrial pacing

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      Transesophageal atrial pacing by means of an electrode catheter placed in the esophagus was attempted in 22 patients for treatment of the following tachyarrhythmias: paroxysmal supraventricular tachycardia (8 patients), atrial flutter (6 patients), atrial fibrillation (3 patients), ventricular tachycardia (3 patients) and nonparoxysmal atroventricular (A–V) junctional tachycardia (2 patients). Atrial pacing was definitely achieved in 17 patients, sinus rhythm was restored in 5 of 8 patients with paroxysmal supraventricular tachycardia and in 1 of 2 patients with nonparoxysmal A–V junctional tachycardia. Atrial pacing failed to restore sinus rhythm in all other types of tachyar-rhythmias treated. In 1 patient with ventricular tachycardia, there was no strong diagnostic evidence for the arrhythmia until atrial pacing was performed and ventricular capture beats became evident. The safety of transesophageal atrial pacing and its advantages over other methods of treatment of tachyarrhythmias are discussed. The results of our study suggest that atrial pacing from the esophagus is the method of choice in the treatment of paroxysmal supraventricular tachycardias and perhaps of nonparoxysmal A–V junctional tachycardias in digitalized patients who require rapid suppression of the arrhythmia. There is also evidence that atrial pacing may be helpful in diagnosing some cases of ventricular tachycardia with a suspected ventricular origin.
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