[Transesophageal study in the diagnostic evaluation of pre-excitation]

Electrophysiologic non-invasive transesophageal testing is compared to intracardiac study in the management of patients with Wolff-Parkinson-White (WPW) syndrome. Transesophageal study can be reliably used to identify the participation of the accessory pathway in reciprocating supraventricular tachycardia and to determine the anterograde conduction properties of the accessory pathway. Using the shortest pre-excited interval during induced atrial fibrillation, or programmed and continuous atrial transesophageal stimulation can markedly reduce the need of intracardiac evaluation. The greater safety and economy of transesophageal compared to the intracardiac technique justify its wider use in preliminary screening of all WPW patients, unless ablative treatment has been clinically indicated, and in evaluating long-term drug protection against a potential deleterious ventricular response during atrial tachyarrhythmias.