Termination of atrial flutter by directed transesophageal atrial pacing during transesophageal echocardiography

Advanced Cardiac Signal Recording

Implantable loop recorders allow prolonged and continuous single-lead electrocardiogram recording, with the pivotal addition of remote monitoring. They have significantly shortened time to electrocardiographic diagnosis and appropriate therapy of many bradyarrhythmias/tachyarrhythmias and proved helpful in arrhythmia burden definition, offering invaluable information in the diagnostic workup for syncope and atrial fibrillation. Advanced cardiac signal recording is also possible by transesophageal catheters. They have been used to orient diagnosis during wide and narrow QRS complex tachycardias and also to perform minimally invasive pacing. Intracardiac electrophysiologic study remains, however, essential for diagnosis of several arrhythmias in the perspective of curative catheter ablation.

Transesophageal left ventricular electrogram-recording and temporary pacing to improve patient selection for cardiac resynchronization

Cardiac resynchronization therapy (CRT) with biventricular pacing (BV) is an established therapy for heart failure (HF) patients with inter- and intraventricular conduction delay. The aim of this pilot study was to test the feasibility of both transesophageal measurement of left ventricular (LV) electrical delay and transesophageal LV pacing prior to implantation, to better select patients for CRT. Esophageal TO8 Osypka catheter was perorally applied in 30 HF patients in position of maximum LV deflection to measure LV electrical delay and to study arterial pulse pressure (PP) during transesophageal bipolar LV pacing. There were 15 responders with a PP increase of a mean 65 ± 24 mmHg to 79 ± 27 mmHg (P < 0.001) and a mean LV electrical delay of 86.8 ± 33 ms. The 15 non-responders with poor PP increase of a mean 63.5 ± 23.5 mmHg to 64.1 ± 23.9 mmHg (P = 0.065) had a significantly smaller LV electrical delay of 36 ± 21 ms (P < 0.001). During a 34 ± 26 month CRT follow-up, the responders New York Heart Association (NYHA) class improved from 3.1 ± 0.35 to 2.1 ± 0.35 (P < 0.001). Determination of left ventricular electrical delay by transesophageal electrogram recording and transesophageal left ventricular pacing may be additional useful techniques to improve patient selection for CRT.