Transesophageal pacing

Crawford W, Plumb VJ, Epstein AE, et al. Prospective evaluation of transesophageal pacing for interruption of atrial flutter. Am J Med 1989 86 663-667. 

Doni F, Della Bella P, Kheir A. Atrial flutter termination by overdrive transesophageal pacing and the facilitating effect of oral propafenone. Am J Cardiol 1995 76 1243-1246. 

Critelli G, et al. Transesophageal pacing for prognostic evaluation of pre-excitation syndrome and assessment of protective therapy. Am J Cardiol 1983 51 513. 

Fig. 2 J Transesophageal echocardiographic view of the right atrium and the right ventricle. There is an oblong mobile vegetation adherent to the pacing lead as it crosses the tricuspid valve attached to its ventricular portion. Patient had positive blood cultures for Staphylococcus lugdunensis. Both these findings are major criteria for the diagnosis of lead endocarditis...

Some authors recommend contralateral reimplantation as early as 36 h after extraction in patients with local symptoms only of device-related infection [10]. In some instances, it is considered safe to perform a contralateral same-day reimplantation [11]. The reasons for a same-day reimplantation are usually pacemaker (PM) dependency or hemodynamic need for CRT in case of biventricular pacing. In fact, the risk of subsequent CIED infections and venous thrombosis increases while maintaining a transvenous temporary device, and for this reason, it cannot be used indefinitely [12]. Same-day reimplantation is considered safe if the patient is clinically proven not to have active systemic bacteremia or infection by blood culture at the time of extraction and there is a lack of transesophageal echocardiographic evidence for endocarditis and the presence of a normal white blood cell count. 

Transesophageal Relatively noninvasive Atrial pacing only Cannot be used long term... 

Benson DW Jr, et al. Transesophageal cardiac pacing history, application, technique. Clin Prog Pacing Electrophysiol 1984 2 360. 

Nishimura M, et al. Optimal mode of transesophageal atrial pacing. Am J Cardiol 1986 57 791. 

Falk RH, Werner M. Transesophageal atrial pacing using a pill electrode for termination of atrial flutter. Chest 1987 92 110-114. 

Blomstrom-Lundqvist C, et al. Transesophageal versus intracardiac atrial stimulation in assessing electrophysiologic parameters of the sinus and AV nodes and of the atrial myocardium. PACE 1987 10 1081. 

Lee CY, Pellikka PA, McCully RB, et al. Nonexercise stress transthoracic echocardiography transesophageal atrial pacing vs. dobutamine stress. J Am Coll Cardiol 1999 33 506-511. 

Fig. 19.20 Lateral chest x-ray from a patient with a dual-unipolar DDD pacing system. The course of the ventricular lead is bizarre and attributed to a very pronounced pectus excavatum chest wall deformity. Capture thresholds were excellent, the paced QRS had a LBBB pattern, and a transesophageal echo confirmed that the lead was in the right ventricle.

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