Atrioventricular sequential pacing using transesophageal atrial pacing in combination with a temporary DDD pacemaker for atrial tracking and ventricular pacing

Abstract

To determine whether atrioventricular (A-V) sequential pacing can be accomplished using transesophageal atrial pacing (TAP) in combination with a temporary DDD pacemaker for tracking the TAP stimuli and pacing the ventricle via temporary epicardial electrodes. Prospective; patients enrolled consecutively. Nonuniversity teaching hospital. Ten adults undergoing cardiac surgery requiring cardiopulmonary bypass. Two to six hours after the termination of cardiopulmonary bypass, atrial pacing was initiated via TAP. The atrial system of a temporary DDD pacemaker was connected to surface electrocardiogram (ECG) electrodes. If the temporary pacemaker could track the TAP stimuli and emit pacing stimuli resulting in ventricular capture, A-V sequential pacing was considered to have occurred. The patients were immediately restudied in the same manner with the change that the temporary DDD pacemaker sensed the TAP stimuli via temporary atrial bipolar epicardial electrodes rather than surface ECG electrodes. Dual pacemaker A-V sequential pacing was accomplished in 17 out of 20 attempts. The atrial system of the temporary DDD pacemaker was able to sense the TAP stimulus via temporary atrial bipolar epicardial leads in 10 out of 10 patients and directly from surface ECG electrodes (right arm/left arm) in 7 out of 10 patients. This report demonstrates that it is possible to A-V sequentially pace using TAP in combination with a temporary DDD pacemaker for tracking the TAP stimulus and pacing the ventricle via temporary epicardial leads. This technique may be useful when A-V sequential pacing is needed and functional temporary atrial leads are not available.