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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2002 November;68(11):825-32

ANESTESIOLOGY 

 ORIGINAL ARTICLES

Transesophageal atrial pacing in the management of re-entry supraventricular tachyarrhy-thmias occurring during general anesthesia

Romano R. 1, Fattorini F. 2, Ciccaglioni A. 2, Rocco A. 2, Moretti G. 2, Cappelletti M. 2, Pietropaoli P. 2

1 Department of Medical and Surgical Emergencies University of Ancona, Ancona, Italy
2 Department of Anesthesiological Sciences Critical Care and Pain Therapy University “La Sapienza”, Rome, Italy

Back­ground. Supra­ven­tric­u­lar tachyar­rhyth­mi­as (­SVTs) rep­re­sent an intra­op­er­a­tive ­risk fac­tor ­that ­should be ­always pre­vent­ed/man­aged. The com­mon­ly ­used ­anti-arrhyth­mic ­drugs are accom­pa­nied by intrin­sic haz­ards, ­such as pro-arrhyth­mic and tox­ic ­effects or unpre­dict­able ­onset and dura­tion of ­action. We under­line the ther­a­peu­tic use of tran­se­soph­a­geal atri­al pac­ing (TAP) for the inter­rup­tion of par­tic­u­lar re-­entry ­SVTs ­occurred dur­ing sur­gi­cal pro­ce­dures in gen­er­al anaesthe­sia.
Meth­ods. Our ­study was car­ried out in 25 ­patients char­ac­ter­ized by a per­son­al clin­i­cal his­to­ry of tran­sient tach­yar­rhyth­mic epi­sodes, sub­ject­ed to gen­er­al anaesthe­sia ­obtained by mid­az­o­lam, pro­pof­ol, N2O e O2, sevof­lu­rane, fen­ta­nil and vec­u­ro­ni­um bro­mide. We ­used TAP ­bursts of 3-5 sec, ­their min­i­mal pac­ing ­rate ­being equiv­a­lent to the tachyar­rhyth­mia ­cycle ­length, ­with an ­impulse inten­sity rang­ing ­from 18 to 25 mA. In ­such con­di­tions, the re-­entry was inter­rupt­ed by the induc­tion of refrac­tori­ness of the ­wave-­front ­that sus­tained the under­ly­ing arrhyth­mo­gen­ic cir­cuit.
­Results. Dur­ing the ­study, the fol­low­ing arrhyth­mi­as ­occurred in 7 out of all ­patients: 1 ­type I atri­al flut­ter, 3 ­nodal tach­y­car­di­as, 1 anti­drom­ic and 2 ortho­drom­ic atri­o­ven­tric­u­lar tach­y­car­di­as, respec­tive­ly. TAP ­assured ­either atri­al cap­ture or ­prompt sup­pres­sion of arrhyth­mi­as in all cas­es. Low inten­sity impuls­es did not ­ever ­allow ven­tric­u­lar cap­ture.
Con­clu­sions. TAP can be con­sid­ered as a val­id ther­a­peu­tic ­device for the man­age­ment of re-­entry ­SVTs ­occurred dur­ing gen­er­al anaesthe­sia, result­ing it effec­tive, ­safe and ­easy-prac­ti­cable.

language: English, Italian


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