Atrial pacing from the esophagus in the diagnosis and management of tachycardia and palpitations

Recent reports have emphasized the usefulness of programmed electrical stimulation of the heart for predicting the effectiveness of pharmacologic therapy of recurrent tachycardias and for determining the basis of recurrent palpitations. We used programmed electrical stimulation of the atrium from the esophagus to study 12 children (ages 1 to 13 years) with either electrocardiographically documented tachycardia (seven patients) or recurrent palpitations (five patients). Atrial stimulation from the esophagus initiated and terminated tachycardia in all seven patients who had a previously documented tachycardia. In five of these patients tachycardia could not be initiated after therapy with quinidine sulfate, and no recurrences have been noted in 12 to 18 months of follow-up. In two patients tachycardia could be reinitiated despite therapeutic quinidine levels, and tachycardia has recurred despite quinidine therapy. Atrial stimulation from the esophagus initiated tachycardia in four of five patients with a history of palpitations. Electrocardiographic documentation of tachycardia was beneficial, because it provided a basis for determining whether therapy for tachycardia was indicated, and in some instances provided an opportunity for patient education to permit-self termination without medication.