Transesophageal electroconversion of atrial reentrant tachycardias early or late following surgery for congenital heart disease

Atrial reentrant tachycardias (ART) are a potentially life-threatening comp lication in survivors of congenital heart disease surgery. From July 1993 t o December 1997, temporary transesophageal pacing was used to convert 29 ta chycardia episodes in 19 patients. At the time of the first tachycardia epi sode, patients' ages were 1 month to 26 years (mean 9.8 yrs). Time from ope ration to onset of first tachycardia episode ranged from 1 day to 19 years. Onset was within the first 2 weeks postoperatively in 6 patients and occur red later in 13 patients (1 to 19 years after operation). Postoperative pac emaker implantation had been performed in 2 pts; 17 of 19 pts were receivin g antiarrhythmic medication. After placing a quadripolar transesophageal catheter, atrial and ventricula r signals were recorded and atrial stimulation performed. Atrial cycle leng th of tachycardia ranged from 160-380 ms with 1:1 to 4.1 AV conduction. Tem porary transesophageal pacing was performed following an algorithm starting with 4 extrastimuli (20 ms below atrial cycle length of tachycardia). Tachycardia terminated in 27 of 29 cases (93%) without complications. In 3 cases, conversion was achieved by pacing after amiodarone 5 mg/kg i.v. Afte r tachycardia conversion, sinus- or pacemaker rhythm was present in 20 case s. In 9 cases atrial fibrillation was recorded; spontaneous conversion to s inus rhythm occurred after a maximum of 3 min (7 cases) of persisted and re quired direct current cardioversion (2 cases). In conclusion, transesophageal atrial pacing is an effective, relatively no ninvasive method for conversion of atrial reentrant tachycardias after oper ation for congenital heart disease.