Faculty Collaboration Database

Role of transesophageal pacing in evaluation of palpitations in children and adolescents. Am J Cardiol 1988 Sep 15;62(9):566-70

Date

09/15/1988

Pubmed ID

3414549

DOI

10.1016/0002-9149(88)90656-x

Scopus ID

2-s2.0-0023770721 (requires institutional sign-in at Scopus site)   42 Citations

Abstract

Transesophageal atrial pacing was used to evaluate the cause of palpitations in 28 patients ages 3 to 18 years (mean 11). Palpitations were defined as the sustained (seconds to minutes) sensation of rapid heart beating. Each patient had had greater than 2 episodes of palpitations. No patient had other evidence of heart disease. Standard electrocardiogram was normal (23 of 28 patients), demonstrated ventricular preexcitation (3 of 28 patients) or demonstrated short PR interval (2 of 28 patients). In selected patients, ambulatory monitoring (11 patients) or exercise testing (3 patients) was performed but failed to demonstrate a cause of palpitations. In an effort to initiate tachycardia, a similar transesophageal atrial pacing protocol was performed in each patient. The protocol consisted of: (1) single extrastimuli at progressively closer intervals during sinus rhythm and after an 8-beat pacing train at greater than or equal to 1 cycle lengths and (2) incremental atrial pacing to the point of second-degree atrioventricular block. If this pacing regimen failed to initiate tachycardia, it was repeated during isoproterenol infusion (0.02, 0.05 and 0.1 micrograms/kg/min) and then following intravenous atropine (0.04 mg/kg) administration. During the study, tachycardia was initiated in 20 of 28 patients (71%) (14 of 15 patients greater than 10 years, 6 of 13 patients less than or equal to 10 years; p less than 0.01, Fisher's exact test). Electrophysiologic characteristics of induced tachycardia suggested reentry within the atrioventricular node (8 of 20 patients) or orthodromic reciprocating tachycardia (12 of 20 patients). In 3 of 12 patients with orthodromic reciprocating tachycardia, a transition to atrial fibrillation was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Author List

Pongiglione G, Saul JP, Dunnigan A, Strasburger JF, Benson DW Jr

Author

Janette F. Strasburger MD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Cardiac Pacing, Artificial
Child
Child, Preschool
Electrocardiography
Electrophysiology
Esophagus
Female
Heart Rate
Humans
Male
Tachycardia