Evaluation of Transesophageal Atrial Pacing Stethoscope in Adult Surgical Patients Under General Anesthesia

Sinus bradycardia (SB) and atrioventricular junctional rhythm (AVJR) commonly cause circulatory insufficiency in anesthetized surgical patients. Treatment is usually with drugs, which can be ineffective or have adverse effects. Cardiac pacing might be preferred, but the transvenous or epicardial routes are too invasive for routine use, and transcutaneous pacing fails to preserve atrial transport function. Transesophageal atrial pacing (TAP) lacks these disadvantages, yet unavailability of inexpensive products has prevented more widespread use. Therefore, a pacing esophageal stethoscope (PES) fabricated by addition of bipolar electrodes to disposable esophageal stethoscopes routinely used for intraoperative monitoring, was evaluated in 100 anesthetized adults. TAP thresholds (10-msec pulses) and hemodynamic effects of TAP as treatment for incidental SB (< or = 60 beats/min) or AVJR were determined. Minimum TAP thresholds (mean +/- standard error) in 48 males were 7.3 +/- 0.3 mA and in 51 females were 8.5 +/- 0.4 mA. Corresponding inferior alveolar ridge-to-electrode distances were 32.5 +/- 0.2 and 30.4 +/- 0.2 cm. For 48 patients with SB < or = 60 beats/min (54 +/- 1 beats/min), TAP (81 +/- 1 ppm) produced average 15, 11, and 14 mmHg increases in systolic, diastolic, and mean arterial pressure, respectively (P < 0.001). For 11 patients with AVJR (71 +/- 5 beats/min), TAP (92 +/- 3 ppm) produced average 23 and 15 mmHg increases in systolic and mean arterial pressure, respectively (P < 0.05). There were no apparent complications of TAP. TAP with a PES appears practical, safe, and effective for prophylaxis and treatment of SB or AVJR in anesthetized surgical patients.