THE ESOPHAGEAL APPROACH IN RHYTHMOLOGY

The possibility of detecting the electrical activity of the heart from the oesophageus has been recognised for nearly a century. On the othe r hand, transesophageal pacing has only been really developped in the last fifteen years, which explains the recent interest for this techni que in clinical practice. Easily put into practice, but not always wel l tolerated, the oesophageal approach has many uses in rhythmology. Th e principal diagnostic applications are in unlabelled tachycardias whe ther with narrow or wide QRS complexes, the evaluation of the Wolff-Pa rkinson-White syndrome, the study of sinus node function or nodal cond uction. The therapeutic applications are dominated by the reduction of supraventricular tachycardias especially atrial flutter, with a succe ss rate similar to that of endocavitary stimulation. The facility of r ealisation, especially at the patient's bedside, without need for fluo roscopie control, makes it a useful tool in emergencies, especially if the endocavitary approach cannot be used. The only reserve is the pai nful character of pacing in some patients.