Esophageal ECG recording--a valuable diagnostic tool in dual chamber pacing

The interpretation of the ECG of a dual chamber pacemaker necessitates the identification of atrial activity. This is a prerequisite for the evaluation of pacemaker function and for the correct adjustment of programmable pulse generators. The assessment of atrial capture in standard 12-lead ECGs is, however, sometimes rather difficult. Esophageal ECG recording by means of a reusable unipolar electrode, inserted transnasally, and connected to a standard ECG recorder, is a simple, rapid and inexpensive method for the reliable identification of P-waves. Clinical examples are presented to illustrate the value of this technique in determining atrial capture and as a tool for the differential diagnosis of pacemaker-involved tachycardias. The use of esophageal ECG recording in the clinical follow-up of patients with dual chamber pacemakers is recommended.