Transesophageal atrial pacing (TAP) for sinus bradycardia during coronary artery bypass grafting: comparison of TAP to intermittent bolus gallamine.

Abstract

OBJECTIVE:

To assess the relative efficacy of a pacing esophageal stethoscope and intermittent boluses (40 mg) of gallamine in correcting sinus bradycardia (SB) during coronary artery surgery.

DESIGN:

The study was prospective, randomized, and controlled.

SETTING:

A community hospital.

PARTICIPANTS:

Fifty patients scheduled for elective coronary artery surgery.

INTERVENTIONS:

The patients were randomly allocated to receive treatment for an SB (less than 60 BPM) with either transesophageal atrial pacing (TAP) or gallamine.

MEASUREMENTS AND MAIN RESULTS:

Heart rate, blood pressure, and systemic hemodynamics were measured. The electrocardiogram was monitored for rate, rhythm, and conduction abnormalities. Twenty-four of the 25 TAP patients could be paced at a rate of 70 BPM after SB. Cardiac index increased from 1.90 to 2.56 L/min/m2. In the gallamine group, heart rate was increased from 50 to 66 BPM, but cardiac index only increased to 2.2 L/min/m2, and 2 patients developed nodal rhythms. Eight of these patients had peak heart rates over 80 BPM, and two were over 90 BPM.

CONCLUSIONS:

The ability to reliably and precisely control heart rate was superior with TAP compared with intermittent bolus dosing with gallamine.

• Authors: R C Tomichek, J A Shields, R E Zimmerman
• Journal: Journal of cardiothoracic and vascular anesthesia (J Cardiothorac Vasc Anesth) Vol. 9 Issue 3 Pg. 259-63 (Jun 1995) ISSN: 1053-0770 [Print] United States
• PMID: 7669957 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Gallamine Triethiodide

Topics

• Arrhythmia, Sinus (drug therapy, therapy)
• Auscultation (instrumentation)
• Blood Pressure (drug effects)
• Bradycardia (drug therapy, therapy)
• Cardiac Output (drug effects)
• Cardiac Pacing, Artificial (methods)
• Coronary Artery Bypass (adverse effects)
• Elective Surgical Procedures
• Electrocardiography (drug effects)
• Esophagus
• Female
• Gallamine Triethiodide (administration & dosage, therapeutic use)
• Heart Atria
• Heart Rate (drug effects)
• Humans
• Injections, Intravenous
• Intraoperative Complications (therapy)
• Male
• Middle Aged
• Prospective Studies