Objective: To develop recommendations for positioning the second-generation
pacing esophageal stethoscope for transesophageal atrial pacing in patient
s positioned prone (P), right lateral decubitus (RLD), and left lateral dec
ubitus (LLD).
Design: Prospective; patients assigned consecutively.
Setting: Tertiary and university hospitals.
Participants: Thirty (10 in each position group) adult patients undergoing
surgery.
Interventions: The optimal depths of insertions (DOL) where pacing current
threshold was minimal (THmin) were determined first when supine, then after
positioning.
Measurements and Main Results: Transesophageal atrial pacing was successful
in all patients supine and after positioning. The optimal DOI varied from
2 cm less deep to 4 cm deeper in positioned patients compared with supine p
atients. Patients positioned P required equal or up to 8 mA greater current
outputs to achieve transesophageal atrial pacing; LLD and RLD patients may
require up to 8 mA greater or lesser current compared with supine patients
.
Conclusion: Transesophageal atrial pacing can be used safely and effectivel
y in patients positioned P, RLD, and LLD. Recommendations are presented for
positioning the pacing esophageal stethoscope. Emphasis is given to using
the lowest DOIs and smallest currents to reduce the chance of transesophage
al ventricular pacing. Copyright (C) 2001 by W.B. Saunders Company.