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European Heart Journal 1992 13(6):763-769;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Electropharmacological testing by transoesophageal atrial pacing in inducible supraventricular tachyarrhythmias

A good approach for selection of long-term anti-arrhythmic therapy

M. GUARNERIO, F. FURLANELLO, G. VERGARA, G. INAMA, M. DEL GRECO*, R. ACCARDI and M. DALLAGO

Divisione di Cardiologia e Centro Aritmologico Ospedale S. Chiara, Trento, Italy
*Divisione di Cardiologia, Ospedale di Rovereto Italy

Received 4 March 1991; revised 23 October 1991; .

Correspondence. Dott. Mauro Guarnerio, Divisione di Cardiologia e Centro Antmologico, Ospedale Santa Chiara, Trento, Italy

Abstract

Sixty-eight patients with disabling episodes of inducible supraventricular tachyarrhythmia were tested electropharmaco-logically by transoesophageal atrial pacing. Using this technique we induced clinical arrhythmia in 67 (98.5%); 26 (38.8%) had a reciprocating tachycardia due to A V node reentry and 41 (61.2%) a by-pass tract. In the latter we induced a reciprocating tachycardia in 12 (29.3%), atrial fibrillation in 25 (36.5%) and both in 14 (34.2%). We then performed an anti-arrhythmic drug test and a transoesophageal reevaluation either after acute intravenous drug administration or during oral steady state. Altogether we tested 111 drugs or a combination of drugs before the results were considered positive; all patients tolerated the procedure well and were discharged with the drug or combination of drugs judged effective. At follow-up of 16.6±8.5 months, 42 patients (62.7%) were symptom-free, 17 (25.3%) had minor and non-disabling relapses, six (9%) stopped the drug because of inefficacy (1–1.5%) or side effects (5–7.5%); two (3%) dropped out.

We conclude that electropharmacological testing with transoesophageal pacing constitutes a very good approach for inducible supraventricular tachyarrhythmias: it permits selection of optimal long-term anti-arrhythmic treatment and is well tolerated, only slightly invasive and without adverse effects.

Key Words: Clinical electrophysiology • anti-arrhythmic drug testing • transoesophageal pacing • supraventricular tachyarrhythmias


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K. Nanthakumar, L. Bergfeldt, and B. Darpo
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[Abstract] [PDF]


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