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The optimal oesophageal pacing technique--the importance of body position, interelectrode spacing, electrode surface area, pacing waveform and intra-oesophageal local anaesthesia.

In order to improve the technique of transoesophageal atrial stimulation (TAS), the effects of body position, interelectrode spacing and electrode surface area on pacing threshold were assessed in two substudies. The effects of intra-oesophageal local anaesthesia and of two different pacing wave configurations on pacing threshold and discomfort were also assessed. Substudy I comprised 16 subjects (3 patients with a history of paroxysmal supraventricular tachycardia and 13 healthy volunteers) and substudy II comprised 16 healthy volunteers. TAS was performed using a hexapolar luminal prototype oesophageal electrode catheter. In substudy I bipolar pacing was performed in the semi-supine and left decubitus body positions for different pulse durations (20, 10, 6 and 2 ms), interelectrode pole distances (10 to 24 mm) and electrode pole surface areas (0.22 to 0.66 cm2). In substudy II TAS was performed with square wave and triangular waveform pulses after intra-oesophageal saline and lidocaine 20 mg/ml. These solutions were given in random order. Neither the interelectrode distance nor electrode surface areas had any significant influence on pacing thresholds. Stimulation thresholds were not affected by body position. Intraoesophageal lidocaine did not affect the discomfort experienced. Peak pacing thresholds using a triangular waveform were significantly higher than thresholds using a square waveformn (p < 0.001). The optimal pacing technique for TAS remains to be defined. The TAS-induced pain is probably not generated from the oesophageal mucous membrane. There is a significant difference in pacing thresholds between triangular and square waveforms.