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Transesophageal indirect atrial pacing for open-heart surgery in children
1Department of Anesthesiology, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Insights
Transesophageal atrial pacing (TAP) is effective in children undergoing cardiac surgery, with a 79.2% success rate for atrial capture. This method offers a viable option for urgent pacing needs in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
Background:
- Transesophageal atrial pacing (TAP) has a long history of clinical application for over 30 years.
- TAP is utilized for cardiac pacing, diagnosis and treatment of arrhythmias, assessing coronary artery disease, and heart rate management.
Purpose of the Study:
- To evaluate the efficacy and side effects of transesophageal atrial pacing (TAP) in children undergoing cardiac surgery.
Main Methods:
- Twenty-four children undergoing open-heart surgery were included.
- A bipolar pacing electrode was inserted into the esophagus to find the optimal site for atrial pacing.
- Continuous ECG, arterial blood pressure, and central venous pressure were monitored during pacing.
Main Results:
- The effective atrial capture rate using TAP was 79.2% (19 out of 24 patients).
- Average parameters for effective pacing included a current of 11.6 mA, pulse duration of 4.8 ms, and electrode insertion length of 19.1 cm.
Conclusions:
- Transesophageal atrial pacing (TAP) is a satisfactory method for pediatric patients during cardiac surgery.
- TAP serves as a potential option for urgent cardiac pacing in this population.
Background:
Transesophageal atrial pacing (TAP) has been successfully applied for clinical use for more than 30 years. Not only for cardiac pacing, or diagnosis and treatment of rhythmic disturbance but also for assessing the presence and severity of coronary artery disease and maintaining adequate heart rate can TAP provide satisfactory effect. In this study we applied TAP on children undergoing the cardiac surgery to evaluate its efficacy and side effects during such major surgery.
Methods:
Twenty-four children (15 M and 9 F) undergoing open-heart surgery with informed consents were included in this study. After induction of anesthesia the bipolar pacing electrode (Tapcath, Arzco Medical Electronics) was inserted into esophagus through the nose until the ideal site for atrial pacing was found by monitoring the esophageal ECG lead (lead I), and then initiation of atrial pacing was performed by applying the transesophageal cardiac stimulator (Arzco Medical Electronics). Continuous ECG, arterial blood pressure and central venous pressure (CVP) were simultaneously monitored and recorded. Patient's height, inserted length of the pacing electrode, current and pulse duration for effective atrial pacing were also recorded.
Results:
The effective rate for initiating sinus tachycardia (atrial capture) by applying TAP was 79.2% (19/24) in our study. For effective atrial pacing the average current was 11.6 +/- 2.4 mA, the average stimulus pulse duration was 4.8 +/- 1.0 ms, and the average inserted length of bipolar electrode was 19.1 +/- 2.2 cm.
Conclusions:
TAP method can be applied satisfactorily in children undergoing cardiac surgery. If urgent cardiac pacing must be applied in these patients TAP would be a choice.