Transesophageal atrial pacing--stimulation and discomfort thresholds: the role of electrode configuration and pulse width.

A balloon catheter with six electrodes has been developed for transesophageal atrial stimulation of the human heart. Introduction is easy and its positioning is simple with the help of six unipolar atrial electrograms. In a group of 20 healthy volunteers, stimulation and discomfort thresholds (intolerable discomfort) were measured for three levels of pulse widths (12, 16, and 20 msec) and for five electrode configurations. Stimulation thresholds were below discomfort thresholds in each case. The stimulation threshold depended on pulse width and not on electrode configuration. The discomfort threshold, however, depended on the electrode configuration and not on the pulse width. A moderate but potentially important increase of the ratio between stimulation threshold and discomfort threshold could be achieved by combining a long pulse width (20 msec) and avoiding the largest distance between the active (cathode) and the passive (anode) electrode. Transesophageal atrial stimulation promises to be a practical noninvasive tool for the termination of regular supraventricular tachycardias, basal electrophysiological studies, and controlled acceleration of the heart rate in the study of myocardial ischemia.