Doppler Echocardiography with Extended Transesophageal Atrial Pacing: Predicting the Efficacy of Permanent Atrial Pacing in the Patient with a Small Left Ventricle and Sinus Node Dysfunction

Abstract

A 2100-g neonate underwent a two-ventricular surgical repair of a right ventricle-dominant unbalanced atrioventricular septal defect associated with the heterotaxy syndrome and sinus node dysfunction. Postoperative congestive heart failure persisted despite bradycardia management by temporary ventricular pacing. Spectral Doppler echocardiographic analysis of pulmonary venous inflow and aortic outflow patterns demonstrated significant improvement with transesophageal atrial pacing. Extended transesophageal pacing was performed for two days, resulting in dramatic clinical improvement. This is the first report of extended transesophageal atrial pacing complementing Doppler echocardiography predicting an improved outcome with permanent atrial pacing.

Successful transesophageal pacing in a very-low-birth-weight-infant with atrioventricular block

“…Also, our case duration of 3.5 hours could be used in future as a base reference for continuous transesophageal pacing in very-lowbirth-weight infants. Previous case reports have only described low-birth-weight infants 5,10 and these two case reports were large discrepancies in the pacing time. One is between short duration during surgery 5 and the other is 2 days.…”

“…One is between short duration during surgery 5 and the other is 2 days. 10 The safe pacing duration is not established in low-birth-weight infants, to say nothing of very-low-birth-weight infants. Although a previous case series study existed only in dogs, which described experimentation in 55 dogs, 9 it showed that more than 4 hours of pacing time increases the risk of oesophageal burn.…”

“…[6][7][8][9] Particularly in newborns, the tissue is vulnerable, and caution is advised with ongoing utilisation. There are only a few reports of continuous use in newborns, 5,6,10 and the lowest weight was 1838 g. 5 In this report, we describe a very-lowbirth-weight (<1500 g) infant with atrioventricular block in whom continuous transesophageal pacing was safely performed for 3.5 hours.…”