Use of the esophageal pill electrode for pacing inhibition of bipolar VVI pacemakers

Abstract

Inhibition of pacing is often needed to analyze the underlying cardiac rhythm and to interpret the 12-lead electrocardiogram (ECG) under various conditions, including acute myocardial ischemia or suspected infarction. Permanent bipolar demand pacemakers are generally more difficult to inhibit than unipolar demand pacemakers using the chest wall stimulation technique. 1 Chest wall twitching and pain may occur at higher stimulation currents and pulse widths. Recently, an easy to swallow pill electrode has become available to record atrial activities to assist in the diagnosis of complex cardiac arrhythmias, in which P waves are not discernible on the surface ECG. 2–4 The pill electrode has been further used for transesophageal atrial pacing with a high current output (≥25 mA). 5 We explored the possibility of using the esophageal pill electrode to deliver stimuli at a lower current (≤20 mA) and pulse width (≤10 ms) to inhibit permanent bipolar VVI pacemakers.