Acute termination of supraventricular tachyarrhythmias in children by transesophageal atrial pacing

S upraventricular tachyarrhythmia, in contrast to arrhythmias in adults, is the most common abnormal tachycardia in infants and chi1dren.l When the tachyarrhythmia is reentrant, conversion by physiologic, pharmacologic or electrical interruption of conduction within a limb of the circuit is highly probable. Manipulation of physiologic vagal tone, the obviously preferred mode, is not successful or feasible in a number of patients. Pharmacologic manipulation has been the most commonly used; however, digoxin and propranolol may require several hours for conversion. Intravenous administration of verapamil offers prompt termination2v3; however, in newborns it may be unsuccessful and carries the risk of hypotension, bradycardia, apnea and negative inotropy, especially in patients with coexisting congestive heart failure.4 Electrical conversion by transvenous atria1 pacing or by direct current cardioversion requires invasive entry for 1 technique and frequently general anesthesia for the other. Recent reports from our institution5-7 as well as from otherssvg have demonstrated the usefulness, simplicity and safety of transesophageal atria1 burst pacing for conversion of reentrant tachyarrhythmias in infants and children. The technique, however, has not been included among the recent recommendations of several authorities.10-12 Our purpose, therefore, is to report our experience with transesophageal pacing in infants and children so that the technique may be more widely known. 43 14f4 8-20 43 5f2 3-10