Transesophageal atrial pacing (TAP) for sinus bradycardia during coronary artery bypass grafting: comparison of TAP to intermittent bolus gallamine.

OBJECTIVE

To assess the relative efficacy of a pacing esophageal stethoscope and intermittent boluses (40 mg) of gallamine in correcting sinus bradycardia (SB) during coronary artery surgery.

DESIGN

The study was prospective, randomized, and controlled.

SETTING

A community hospital.

PARTICIPANTS

Fifty patients scheduled for elective coronary artery surgery.

INTERVENTIONS

The patients were randomly allocated to receive treatment for an SB (less than 60 BPM) with either transesophageal atrial pacing (TAP) or gallamine.

MEASUREMENTS AND MAIN RESULTS

Heart rate, blood pressure, and systemic hemodynamics were measured. The electrocardiogram was monitored for rate, rhythm, and conduction abnormalities. Twenty-four of the 25 TAP patients could be paced at a rate of 70 BPM after SB. Cardiac index increased from 1.90 to 2.56 L/min/m2. In the gallamine group, heart rate was increased from 50 to 66 BPM, but cardiac index only increased to 2.2 L/min/m2, and 2 patients developed nodal rhythms. Eight of these patients had peak heart rates over 80 BPM, and two were over 90 BPM.

CONCLUSIONS

The ability to reliably and precisely control heart rate was superior with TAP compared with intermittent bolus dosing with gallamine.