Atrial flutter termination by overdrive transesophageal pacing and the facilitating effect of oral propafenone
Abstract
Transesophageal overdrive atrial pacing is effective and safe for atrial flutter termination. The influence of antiarrhythmic drug therapy on this procedure is controversial. In this study, we investigated whether oral propafenone may facilitate this procedure. Thirty patients with type I atrial flutter were randomized into 2 groups in which transesophageal pacing was attempted: group A, without treatment; and group B, after oral administration of propafenone 600 mg. Transesophageal pacing was effective in interrupting atrial flutter in 53% of patients (8 of 15) in group A and in 87% of patients (13 of 15) in group B. A significant lengthening of the flutter cycle was observed with respect to the baseline in patients given propafenone (261 +/- 23 vs 217 +/- 25, p < 0.01). Sinus rhythm resumed at a shorter paced cycle in group A patients (166 +/- 13 vs 187 +/- 14 ms, p < 0.01). The transesophageal threshold for stable atrial capture was significantly lower in group A (20.5 +/- 0.2 vs 23.3 +/- 1.2, p < 0.01). In no patient was the threshold for atrial capture higher than the pain threshold. We did not observe abrupt enhancement of atrioventricular conduction. We conclude that propafenone is effective and safe when used with transesophageal pacing in the termination of atrial flutter. The slowing effect of the drug on intraatrial conduction and the possible stabilizing effect on the reentry circuit appear to be outweighed by the positive effect of propafenone on the excitable gap of the circuit, facilitating its capture and accounting for the beneficial effect of the drug on arrhythmia termination.
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Atrial pacing at rates above the flutter rate via a transvenous catheter can terminate atrial flutter in a large proportion of cases.
“Alternatively, AFL interruption can be achieved in a large percentage of cases by atrial pacing at rates above the AFL rate, through a transvenous catheter.”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [146]
High-output stimulation can also be delivered through the oesophagus to terminate atrial flutter.
“Using high output stimulation this technique can also be applied through the oesophagus.145 -148”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [146]
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- Authors
- Doni, F., Bella, P. D., Kheir, A., Manfredi, M., Piemonti, C., Staffiere, E., Rimondini, A., & Fiorentini, C.
- Corresponding author
- Doni, Flavio
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 1995-12
- Volume
- 76
- Issue
- 17
- Pages
- 1243-1246
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2061010504
- Cited by
- 29
- References
- 26
- Citations by year
- 2025: 2 · 2022: 2 · 2020: 1 · 2016: 3
- FWCI
- 1.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial flutter, transesophageal pacing, overdrive pacing, propafenone, antiarrhythmic drugs, reentrant circuit, excitable gap, sinus rhythm restoration, atrioventricular conduction
- MeSH terms
- Administration, Oral, Anti-Arrhythmia Agents, Atrial Flutter, Cardiac Pacing, Artificial, Electrocardiography, Heart Conduction System, Humans, Propafenone, Prospective Studies
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