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Abstract
Sinus bradycardia (SB) or atrioventricular junctional rhythm (AVJR) may produce circulatory
insufficiency in anesthetized surgical patients, especially those with cardiovascular
disease. Chronotropic drugs have been the preferred initial treatment, except when
epicardial pacing is available. Alternative methods include transvenous or transcutaneous
pacing. Drugs may be ineffective or have undesirable effects. Transvenous pacing is
time consuming and risky, and transcutaneous pacing is not universally applicable
or effective. Transesophageal atrial pacing (TAP) lacks these disadvantages, but unavailability
of equipment and unfamiliarity with the method has discouraged widespread use. Feasibility
of TAP as prophylaxis for intraoperative SB or AVJR was tested with approved or investigational
devices in 200 anesthetized surgical patients, not necessarily with cardiovascular
disease or having cardiac surgery. Of these, 84 later had incidental SB ≤60 beats/min,
and 23 of these 84 had SB ≤50 beats/min. Thirteen patients had AVJR (72 ± 4 beats/
min; mean ± SEM). TAP at 80 beats/min for SB, or at a rate sufficient to overdrive
AVJR, was effective initial treatment in all patients. Respective average increases
in systolic, diastolic, and mean arterial pressures for patients with SB ≤60 beats/
min were 14,12, and 14 mmHg (P < .001); for SB ≤50 beats/min 22,17, and 19 mmHg (P < .001); and for AVJR 23 (P < .01), 9 (NS), and 15 mmHg (P < .05), respectively. For patients with cardiac output measurements the average increase
for SB ≤60 beats/min was 1.4 L/min (N = 13, P < .01); for SB ≤50 beats/min 1.8 L/min (N = 7, P < .05); and for AVJR was 2.6 L/mmin (N = 2). There were no apparent complications
of TAP as prophylaxis or treatment for SB or AVJR. TAP has been shown to be a safe,
simple, rapid, and effective method for prophylaxis and initial treatment of intraoperative
SB or AVJR. Potential advantages of TAP over drugs are discussed.
Keywords
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Article info
Footnotes
☆Transesophageal pacing equipment used for these studies was furnished courtesy of Arzco Medical Systems, Inc, Vernon Hills, IL.
Identification
Copyright
© 1993 Published by Elsevier Inc.
