Safety of transesophageal pacing for 24 hours in a canine model

Temporary epicardial pacing is often necessary following surgical correction of congenital heart disease. Epicardial pacing wires, while generally effective, can, however, become nonfunctional. Transesophageal atrial pacing (TEAP) can be a useful adjunct in this setting. The potential for esophageal damage with sustained TEAP is unknown. We assessed the safety of continuous (24 hours) TEAP by evaluating gross and histological changes to the esophagus in a canine model.

Thirteen juvenile beagle dogs were fitted with a 4-Fr multipolar catheter placed transnasally into the esophagus to a level to sustain atrial capture. Pacing was established in nine dogs for 24 hours while four control dogs had catheters but no pacing stimulus applied. Paced dogs were divided into two groups: group A (n = 5) that were euthanized immediately and group B (n = 4) that were euthanized 7 days after the pacing period. Nonpaced dogs (group C, n = 4) were treated similar to group A. Gross and histological examination of the esophageal tissue was completed.

Gross and histological evidence of mild esophagitis was noted in dogs from groups A and C but not in dogs from group B. There was no evidence of esophageal stricture or fibrosis in any dog from any group.

TEAP did not result in permanent esophageal changes after 24 hours of stimulation. Microscopic lesions of mild erosive esophagitis, seen after 24 hours of TEAP, were absent 7 days postpacing. Mechanical irritation from the catheter cannot be ruled out as a cause of these changes.