Sensing through the esophagus for temporary atrial synchronous ventricular VDD pacing

Area of Science:

• Cardiology
• Biomedical Engineering
• Electrophysiology

Background:

• Severe atrioventricular (AV) conduction disturbances necessitate effective pacing solutions.
• Temporary pacing is crucial in managing acute cardiac conditions.
• Esophageal electrode technology offers a less invasive alternative for cardiac monitoring and pacing.

Purpose of the Study:

• To assess the efficacy and safety of temporary VDD pacing utilizing an esophageal electrode for atrial electrogram sensing.
• To determine the reliability and stability of this pacing method in patients with AV conduction issues.

Main Methods:

• A cohort of 15 patients with severe AV conduction disturbances underwent temporary VDD pacing.
• A 24-hour beat-to-beat ECG analysis was employed to evaluate pacing effectiveness.
• Stability tests were conducted during various physiological activities like swallowing and coughing.

Main Results:

• The esophageal electrode pacing system was satisfactory in 12 out of 15 patients.
• 24-hour Holter monitoring showed 96.32% VDD pacing, with minimal VVI (2.92%) and pseudosensing (0.14%) beats.
• Pacing stability was affected by patient position (lying on right side), swallowing, and coughing, leading to increased VVI beats.

Conclusions:

• Temporary VDD pacing with an esophageal electrode is a safe and effective technique for patients with severe AV conduction disturbances.
• The system demonstrates reliable atrial sensing and pacing, with a low incidence of pseudosensing.
• While generally stable, certain activities can transiently impact pacing mode, highlighting areas for further refinement.