[Diagnostic transoesophageal atrial stimulation].

BACKGROUND

We wanted to evaluate transoesophageal atrial stimulation as a diagnostic tool in the evaluation of paroxysmal supraventricular tachycardias.

MATERIAL AND METHODS

185 procedures in 177 patients were evaluated retrospectively. The main reasons for referral to transoesophageal atrial stimulation were documented (52%) or suspected (43%) paroxysmal supraventricular tachycardias. The procedure consisted of incremental atrial stimulation to second degree A-V block, adding up to three extra stimuli, repeating the protocol with isoprenalin 2 and 5 mg/min and completing the procedure with rapid atrial stimulation 300-800/min. Induced tachycardias were classified according to the R-P interval.

RESULTS

The procedure was well tolerated. Supraventricular tachycardias were induced in 72/96 (75%) of patients with documented paroxysmal supraventricular tachycardias and in 41/80 (51%) of patients with suspected paroxysmal supraventricular tachycardias. Out of the 101 patients (55%) who were referred for invasive electrophysiological study, 79 (78%) had an inducible supraventricular tachycardia at transoesophageal stimulation. When stimulation resulted in a tachycardia with measurable R-P interval, the accuracy of our diagnosis was 87%.

INTERPRETATION

Transesophageal atrial stimulation has proved to be a useful diagnostic tool in the management of paroxysmal supraventricular tachycardias at our hospital. Nearly half the patients required no further investigations after transoesophageal atrial stimulation.