A comparison of transoesophageal atrial pacing and direct current cardioversion for the termination of atrial flutter: a prospective, randomised clinical trial.
OBJECTIVE
To compare the safety and efficacy of transoesophageal atrial pacing (TAP) with an easily swallowed pill electrode and direct current cardioversion (DCC) in patients with atrial flutter that was refractory to appropriate medical treatment.


METHODS
Prospective, randomised clinical trial.


METHODS
Community based United States naval hospital.


METHODS
Twenty one consecutive patients with refractory atrial flutter selected consecutively from the inpatient cardiology consultation service. All patients were haemodynamically stable and medical treatment with a class IA or IC antiarrhythmic agent had failed. Eleven patients were treated with TAP and 10 patients were treated with DCC.


METHODS
Digoxin was given to all patients to control the ventricular rate to < 100/minute.


METHODS
Conversion to normal sinus rhythm and arrhythmias after cardioversion.


RESULTS
Conversion to normal sinus rhythm was similar in both groups (TAP 8/11, DCC 9/10, p = 0.31). Arrhythmias after cardioversion including third degree heart block and non-sustained ventricular tachycardia were more frequent in the DCC group (TAP 0/11, DCC 6/10, p = 0.02).


CONCLUSIONS
Transoesophageal atrial pacing with an easily swallowed pill electrode is safe, well tolerated, and is as efficacious as DCC for refractory atrial flutter.
Tucker
K J
KJ
Department of Medicine, Naval Hospital, Oakland, California.
Wilson
C
C
D000368:Aged; D000369:Aged, 80 and over; D001282:Atrial Flutter / Q000503:physiopathology / Q000628:therapy*; D016275:Atrial Function / Q000502:physiology; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D004554:Electric Countershock / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies