[Emergency 12-hour transesophageal stimulation in a 21-month-old infant]

In a 21-month-old child with complex cyanotic congenital heart disease an aortopulmonary shunt was created as preparation for a modified Fontan operation. During the early postoperative period low cardiac output with right atrial pressures of 20 mm Hg developed due to a slow ventricular tachycardia (ventricular rate 135 bpm). Pharmacological interventions (isoprenaline 0.01 mg/kg hourly and lidocaine 1 mg/kg hourly were without any effect. As epicardial pacing leads had not been implanted during surgery, atrial pacing was performed via the transoesophageal route using a 9.5-F bipolar electrode catheter with an interelectrode distance of 15 mm. Atrial capture could be established with an impulse width of 9.9 ms and 10 mA output at a rate of 150 bpm. With restoration of atrioventricular synchronicity, right atrial pressure finally decreased to 10 mm Hg with consecutive stabilization of the cardiovascular status. After 12.5 h transoesophageal pacing could be stopped without any problems due to spontaneous cessation of ventricular tachycardia. No clinical signs of oesophageal injury were noted. It is concluded that transoesophageal pacing is a practical, safe and effective method for emergency cardiac pacing.