Usefulness of transesophageal atrial pacing in hyperkalemia-induced impulse formation and conduction disturbances

This report describes the usefulness of transesophageal atrial pacing in the treatment of five patients with hyperkalemia-induced bradycardias. Three patients had marked sinus bradycardia while the other two had a regular rhythm with QRS of left bundle branch block morphology, with no P waves visible on the surface electrocardiogram. Four patients were in chronic hemodialysis three times a week, and one had severe post-traumatic hemorrhage. In three patients, hyperkalemia had been precipitated by food intoxication. In one case the cause was unknown while, in the last case, hyperkalemia was due to rapid infusion of stored blood and solutions containing high concentrations of potassium. Transesophageal atrial pacing was performed in all cases utilizing a bipolar catheter introduced into the esophagus and a constant current generator delivering square wave pulses of 10 msec duration and 19-28 mA intensity. Atrial capture, followed by impulse conduction to the ventricles, was constant in all cases, being performed for between 15 and 35 minutes until a normal sinus rhythm was restored. The procedure was well tolerated. The advantages of this procedure as opposed to invasive ventricular pacing are discussed.