Sung C S, Tsai S K, Chu M, Lee T Y
Department of Anesthesiology, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1995 Jan;55(1):58-63.
Transesophageal atrial pacing (TAP) has been successfully applied for clinical use for more than 30 years. Not only for cardiac pacing, or diagnosis and treatment of rhythmic disturbance but also for assessing the presence and severity of coronary artery disease and maintaining adequate heart rate can TAP provide satisfactory effect. In this study we applied TAP on children undergoing the cardiac surgery to evaluate its efficacy and side effects during such major surgery.
Twenty-four children (15 M and 9 F) undergoing open-heart surgery with informed consents were included in this study. After induction of anesthesia the bipolar pacing electrode (Tapcath, Arzco Medical Electronics) was inserted into esophagus through the nose until the ideal site for atrial pacing was found by monitoring the esophageal ECG lead (lead I), and then initiation of atrial pacing was performed by applying the transesophageal cardiac stimulator (Arzco Medical Electronics). Continuous ECG, arterial blood pressure and central venous pressure (CVP) were simultaneously monitored and recorded. Patient's height, inserted length of the pacing electrode, current and pulse duration for effective atrial pacing were also recorded.
The effective rate for initiating sinus tachycardia (atrial capture) by applying TAP was 79.2% (19/24) in our study. For effective atrial pacing the average current was 11.6 +/- 2.4 mA, the average stimulus pulse duration was 4.8 +/- 1.0 ms, and the average inserted length of bipolar electrode was 19.1 +/- 2.2 cm.
TAP method can be applied satisfactorily in children undergoing cardiac surgery. If urgent cardiac pacing must be applied in these patients TAP would be a choice.
经食管心房起搏（TAP）已成功应用于临床30多年。TAP不仅在心脏起搏、心律失常的诊断和治疗方面，而且在评估冠状动脉疾病的存在和严重程度以及维持适当心率方面都能提供令人满意的效果。在本研究中，我们将TAP应用于接受心脏手术的儿童，以评估其在这种大手术中的疗效和副作用。
本研究纳入了24例（男15例，女9例）接受心脏直视手术且签署知情同意书的儿童。麻醉诱导后，将双极起搏电极（Tapcath，Arzco Medical Electronics）经鼻插入食管，通过监测食管心电图导联（I导联）找到理想的心房起搏部位，然后使用经食管心脏刺激器（Arzco Medical Electronics）启动心房起搏。同时连续监测并记录心电图、动脉血压和中心静脉压（CVP）。还记录了患者的身高、起搏电极插入长度、有效心房起搏的电流和脉冲持续时间。
在我们的研究中，应用TAP启动窦性心动过速（心房捕获）的有效率为79.2%（19/24）。有效心房起搏的平均电流为11.6±2.4 mA，平均刺激脉冲持续时间为4.8±1.0 ms，双极电极的平均插入长度为19.1±2.2 cm。
TAP方法可令人满意地应用于接受心脏手术的儿童。如果这些患者必须进行紧急心脏起搏，TAP将是一种选择。
