Atrial flutter cardioversion in pediatric patients by postoperative transesophageal pacing

Background: This study aims to evaluate the efficacy and safety of transesophageal atrial pacing for the restoration of sinus rhythm in the intraatrial reentrant tachycardia treatment. Methods: A total of 16 patients (8 males, 8 females; mean age 8.3 years; range 6 days to 19 years) who underwent transesophageal atrial pacing for cardioversion of atrial flutter were included in the study. Atrial pacing was instituted at a cycle length equal to that of the atrial flutter and continued for a period of 30 seconds to one minute with 10 milliseconds decrements until a paced cycle length of 120 milliseconds was achieved or the flutter was terminated. If sustained atrial fibrillation was induced or the sinus rhythm could not be restored despite maximal transesophageal atrial pacing, direct current cardioversion was performed. Results: Sinus rhythm was achieved in 11 of 18 episodes (61%). The median tachycardia cycle length was 210 milliseconds (range 190 to 300 milliseconds). Overdrive transeophageal atrial burst stimulation was performed at a cycle length of 280-120 milliseconds. Direct current cardioversion was performed in six patients (33%). Overdrive pacing was successful in all patients under oral antiarrhythmic therapy. Median follow-up was 3.15 years (1-6 years). Conclusion: Transesophageal atrial pacing is a safe and effective treatment modality for atrial flutter, especially in patients with a compromised cardiovascular reserve. It should be preferred as first line treatment before direct current cardioversion for sinus rhythm achievement especially in pediatric patients and patients who were performed open heart surgery.