Transesophageal pacemaker therapy in atrial flutter after procainamide pretreatment

Area of Science:

• Cardiology
• Electrophysiology

Background:

• Atrial flutter is a common supraventricular tachyarrhythmia.
• Transesophageal atrial stimulation is a method for terminating atrial flutter.
• Pharmacological pretreatment may influence the success of electrical cardioversion.

Purpose of the Study:

• To compare the efficacy of digoxin versus procainamide pretreatment in facilitating transesophageal atrial stimulation for terminating atrial flutter.

Main Methods:

• Fifty-six patients with atrial flutter were randomized into two groups.
• Group A received digoxin pretreatment; Group B received procainamide pretreatment.
• Transesophageal atrial stimulation using a programmable stimulator and esophageal electrode catheters was employed.

Main Results:

• Procainamide pretreatment resulted in a higher success rate for converting atrial flutter to sinus rhythm or atrial fibrillation compared to digoxin.
• Specifically, procainamide facilitated cardioversion in 24 out of 26 patients, while digoxin facilitated it in 27 out of 30 patients.
• The difference in efficacy between procainamide and digoxin was statistically significant (P < 0.05).

Conclusions:

• Procainamide is more efficacious than digoxin in facilitating cardioversion of atrial flutter by transesophageal atrial stimulation.
• Pharmacological pretreatment plays a role in the success of non-invasive arrhythmia termination techniques.