Transoesophageal pacing

The oesophageal or gastro-oesophageal approach has been advocated for emergency ventricular pacing as it may be better tolerated than external pacing in the conscious patient.12 Success rates of around 90% are claimed for ventricular stimulation using a flexible electrode positioned in the fundus of the stomach and pacing through the diaphragm. Tran-soesophageal atrial pacing (performed by placing the electrode in the mid to lower oesophagus to obtain atrial capture) is also well described,13 14 but this approach is rarely used

Figure 22.2. Typical anteroposterior positioning of transcutaneous pacing electrodes

in the acute setting as electrode stability can be difficult to achieve and there is no protection against atrioventricular conduction disturbance.

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