Transesophageal Recording and Pacing Techniques for Evaluation of Patients with Preexcitation

  • David C. Chung
  • Charles R. Kerr


Preexcitation of the ventricle may be associated with (1) one or more accessory (anomalous) atrioventricular (AV) pathways, (2) an atriofascicular bypass tract, (3) an intranodal bypass tract, or (4) a nodoventricular or fasciculoventricular connection. However, ventricular preexcitation in association with an accessory AV pathway seen in the so-called WolffParkinson-White (WPW) syndrome [1–5] is the most common. Victims of this syndrome frequently have disabling and occasionally life-threatening arrhythmias [6–12]. The term preexcitation syndrome is used in this chapter to mean the WPW syndrome unless otherwise stated.


Atrial Fibrillation Supraventricular Tachycardia Accessory Pathway Atrial Pace Versus Pathway 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Wolff L, Parkinson J, White PD: Bundle branch block with short P-R interval in healthy young people prone to paroxysmal tachycardia. Am. Heart J. 5: 685, 1930.CrossRefGoogle Scholar
  2. 2.
    Wolff L: Anomalous atrioventricular excitation (Wolff-Parkinson-White syndrome). Circulation 19: 14, 1959.PubMedGoogle Scholar
  3. 3.
    Wolff L: The WPW syndrome. Am. Heart J. 63: 284, 1962.CrossRefGoogle Scholar
  4. 4.
    Zipes DP, Rothbaum DA, DeJoseph RL: Pre-excitation syndrome. Cardiovasc. Clin. 6: 209, 1974.PubMedGoogle Scholar
  5. 5.
    Gallagher JJ, Pritchett ELC, Sealy WC, Kasell J, Wallace AG: The preexcitation syndromes. Prog. Cardiovasc. Dis. 20: 285, 1978.PubMedCrossRefGoogle Scholar
  6. 6.
    Wolff L and White PD: Syndrome of short P-R interval with abnormal QRS complexes and paroxysmal tachycardia. Arch. Intern. Med. 28: 446, 1948.CrossRefGoogle Scholar
  7. 7.
    Wolff L: Syndrome of short P-R interval with abnormal QRS complexes and paroxysmal tachycardia (WPW syndrome). Circulation 10: 282, 1954.PubMedGoogle Scholar
  8. 8.
    Chung KY, Walsh TJ, Massie E: WolffParkinson-White syndrome. Am. Heart J. 69: 116, 1965.PubMedCrossRefGoogle Scholar
  9. 9.
    Newman BJ, Donoso E, Friedberg CK: Arrhythmias in the Wolff-Parkinson-White syndrome. Prog. Cardiovasc. Dis. 9: 147, 1966.PubMedCrossRefGoogle Scholar
  10. 10.
    Chung EK: Wolff-Parkinson-White Syndrome - Current Views. Am. J. Med. 62: 252, 1977.PubMedCrossRefGoogle Scholar
  11. 11.
    Kaplan MA and Cohen KL: Ventricular Fibrillation in the Wolff-Parkinson-White syndrome. Am. J. Cardiol. 24: 259, 1969.PubMedCrossRefGoogle Scholar
  12. 12.
    Campbell RWF, Smith RA, Gallagher JJ, Pritchett ELC, Wallace AG: Atrial fibrillation in the preexcitation syndrome. Am. J. Cardiol. 40: 514, 1977.PubMedCrossRefGoogle Scholar
  13. 13.
    Graybiel A, McFarland RA, Gates DC, Webster FA: Analysis of the electrocardiograms obtained from 1,000 young health aviators. Am. Heart J. 27: 524, 1944.CrossRefGoogle Scholar
  14. 14.
    Manning GW: Electrocardiography in the selection of Royal Canadian Air Force aircrew. Circulation 10: 401, 1954.PubMedGoogle Scholar
  15. 15.
    Packard JM, Graettinger JS, Graybiel A: Analysis of the electrocardiograms obtained from 1,000 young healthy aviators: ten year follow-up. Circulation 10: 384, 1954.PubMedGoogle Scholar
  16. 16.
    Averill KH, Fosmoe RJ, Lamb LE: Electrocardiographic findings in 67,375 asymptomatic subjects: IV. Wolff-Parkinson-White syndrome. Am. J. Cardiol. 6: 108, 1960.PubMedCrossRefGoogle Scholar
  17. 17.
    Wolff L. and White PD: The cardinal aspects of paroxysmal rapid heart action. N. Engl. J. Med. 226: 640, 1942.CrossRefGoogle Scholar
  18. 18.
    Öhnell RF: Pre-excitation, a cardiac abnormal ity. PA Norstedt and Loner: Stockholm, 1944.Google Scholar
  19. 19.
    Willus FA and Carryer HM: Electrocardiograms displaying short P-R intervals with prolonged QRS complexes: An analysis of sixty-five cases. Proc. Staff Meet., Mayo Clin. 21: 438, 1946.Google Scholar
  20. 20.
    Hejtmancik MT and Herrman GR: The electrocardiographic syndrome of short P-R interval and broad QRS complexes: A clinical study of 80 cases. Am. Heart J. 54: 708, 1957.PubMedCrossRefGoogle Scholar
  21. 21.
    Hecht HH, Kennamer R, Prinzmetal M, Rosenbaum FF, Sodi-Pallares D, Wolff L, Brooks C, Pick A, Rijlant P, Robb JS: Anomalous atrioventricular excitation. Panel discussion, Ann. N.Y. Acad. Sci. 65: 826, 1956.CrossRefGoogle Scholar
  22. 22.
    Wellens HJJ, Schuilenburg RM, Durrer D: Electrical stimulation of the heart in patients with Wolff-Parkinson-White syndrome, type A. Circulation 43: 99, 1971.PubMedGoogle Scholar
  23. 23.
    Fontaine G, Frank R, Goutte R, et al.: Rhythme reciproque antidromique dans un syndrome de Wolff-Parkinson-White de type A. Ann. Cardiol. Angeiol. (Paris), 59: 59, 1975.Google Scholar
  24. 24.
    Zipes DP, DeJoseph RL, Rothbaum DA: Unusual properties of accessory pathways. Circulation 49: 1200, 1974.PubMedGoogle Scholar
  25. 25.
    Neuss H, Schlepper M, Thormann J: Analysis of reentry mechanisms in three patients with concealed Wolff-Parkinson-White syndrome. Circulation 51: 75, 1975.PubMedGoogle Scholar
  26. 26.
    Tonkin AM, Gallagher JJ, Svenson RH, Wallace AG, Sealy WC: Antegrade block in accessory pathways with retrograde conduction in reciprocating tachycardia. Eur. J. Cardiol. 3: 143, 1975.PubMedGoogle Scholar
  27. 27.
    Sung RJ, Castellanos A, Gelband H, Myerburg RJ: Mechanism of reciprocating tachycardia during sinus rhythm in concealed Wolff-ParkinsonWhite syndrome. Circulation 54: 338, 1976.PubMedGoogle Scholar
  28. 28.
    Dreifus LS, Haiat R, Watanabe Y, Arriaga J, Reitman N: Ventricular fibrillation: A possible mechanism of sudden death in patients with Wolff-Parkinson-White syndrome. Circulation 43: 520, 1971.PubMedGoogle Scholar
  29. 29.
    Klein GJ, Bashore TM, Sellers TD, Pritchett ELC, Smith WM, Gallagher JJ: Ventricular fibrillation in the Wolff-Parkinson-White syndrome. N. Engl. J. Med. 301: 1080, 1979.PubMedCrossRefGoogle Scholar
  30. 30.
    Wellens HJ and Durrer D: Effect of digitalis on atrioventricular conduction and circus-movement tachycardias in patients with WolffParkinson-White syndrome. Circulation 47: 1229, 1973.PubMedGoogle Scholar
  31. 31.
    Sellers TD, Bashore, TM, Gallagher JJ: Digitalis in the pre-excitation syndrome: Analysis during atrial fibrillation. Circulation 56: 260, 1977.PubMedGoogle Scholar
  32. 32.
    Byrum CJ, Wahl RA, Behrendt DM, Dick M: Ventricular fibrillation associated with use of digitalis in a newborn infant with WolffParkinson-White syndrome. J. Pediatr. 101: 400, 1982.PubMedCrossRefGoogle Scholar
  33. 33.
    Neuss H and Schlepper M: Influence of various antiarrhythmic drugs (aprindine, ajmaline, verapamil, oxprenolol, orciprenaline) on the functional properties of accessory AV pathways. Acta Cardiol. 18 (suppl): 279, 1974.PubMedGoogle Scholar
  34. 34.
    Petri H, Kafka W, Hall D, Rudolph W: Potential acceleration of the ventricular rate in WPW with atrial fibrillation after verapamil. Circulation 62 (suppl III): III - 262, 1980.Google Scholar
  35. 35.
    Gulamhusein S, Ko P, Carruthers SG, Klein GJ: Acceleration of the ventricular response during atrial fibrillation in the Wolff-Parkinson-White syndrome after verapamil. Circulation 65: 348, 1982.PubMedCrossRefGoogle Scholar
  36. 36.
    Cremer M: Ueber die direkte ableitung der aktionsstrome der menschlichen herzens vom oesophagus and ueber das elektrokardiogramm des foetus. Munchen Med. Wchnschr., 53: 811, 1906.Google Scholar
  37. 37.
    Lieberson A and Liberson F: An internal electrocardiographic lead. Proc. Soc. Exp. Biol. Med. 31: 441, 1934.Google Scholar
  38. 38.
    Brown WH: A study of the esophageal lead in clinical electrocardiography: Part I. The application of the esophageal lead to the human subject with observations on the Ta-wave, extrasystoles and bundle-branch block. Am. Heart J. 12: 1, 1936.CrossRefGoogle Scholar
  39. 39.
    Brown WH: A study of the esophageal lead in clinical electrocardiography: Part II. An electrocardiographic study of auricular disorders in the human subject by means of the esophageal lead. Am. Heart J. 12: 307, 1936.CrossRefGoogle Scholar
  40. 40.
    Butterworth S and Poindexter CA: The esophageal electrocardiogram in arrhythmias and tachycardias. Am. Heart J. 32: 681, 1946.PubMedCrossRefGoogle Scholar
  41. 41.
    Kistin AD, Brill WD, Robb GP: Normal esophageal and gastric electrocardiograms: Description, statistical analysis and bearing on theories of “eletrocardiographic position.” Circulation 2: 578, 1950.PubMedGoogle Scholar
  42. 42.
    Enselberg CD: The esophageal electrocardiogram in the study of atrial activity and cardiac arrhythmias. Am. Heart J. 41: 382, 1951.PubMedCrossRefGoogle Scholar
  43. 43.
    Oblath R and Karpman H: The normal esophageal lead electrocardiogram. Am. Heart J. 41: 369, 1951.PubMedCrossRefGoogle Scholar
  44. 44.
    Kistin AD and Bruce JC: Simultaneous esophageal and standard electrocardiographic leads for the study of cardiac arrhythmias. Am. Heart J. 53: 65, 1957.PubMedCrossRefGoogle Scholar
  45. 45.
    Rubin IL, Jagendorf B, Goldberg AL: The esophageal lead in the diagnosis of tachycardias with aberrant ventricular conduction. Am. Heart J. 57: 19, 1959.PubMedCrossRefGoogle Scholar
  46. 46.
    Jenkins JM, Wu D, Arzbaecher RC: Computer diagnosis of supraventricular and ventricular arrhythmias: A new esophageal technique. Circulation 60: 977, 1979.PubMedGoogle Scholar
  47. 47.
    Benditt DG, Pritchett ELC, Smith WM, Gallagher JJ: Ventriculoatrial intervals: Diagnostic use in paroxysmal supraventricular tachycardia. Ann. Intern. Med. 91: 161, 1979.PubMedGoogle Scholar
  48. 48.
    Gallagher JJ, Smith WM, Kasell J, Smith WM, Grant AO, Benson DW, Jr: Use of the esophageal lead in the diagnosis of mechanisms of reciprocating supraventricular tachycardia. PACE 3: 440, 1980.PubMedCrossRefGoogle Scholar
  49. 49.
    Zoll PM: Resuscitation of the heart in ventricular standstill by external electrical stimulation. N. Engl. J. Med. 247: 768, 1952.PubMedCrossRefGoogle Scholar
  50. 50.
    Shafiroff BFP and Linder J: Effects of external electrical pacemaker stimuli on the human heart. J. Thorac. Cardiovasc. Surg. 33: 544, 1957.Google Scholar
  51. 51.
    McNally EM, Meyer EC, Langendorf R: Elective countershock in unanesthetized patients with use of an esophageal electrode. Circulation 33: 124, 1966.PubMedGoogle Scholar
  52. 52.
    Burack B and Furman S: Transesophageal cardiac pacing. Am. J. Cardiol. 23: 469, 1969.PubMedCrossRefGoogle Scholar
  53. 53.
    Lubell DL: Cardiac pacing from the esophagus. Am. J. Cardiol. 27: 641, 1971.PubMedCrossRefGoogle Scholar
  54. 54.
    Stopczyk MJ, Zochowski RJ, Sadowski Z: P wave triggered permanent atrial pacing in a case of transient sinus arrest. Br. Heart J. 34: 318. 1972.PubMedCrossRefGoogle Scholar
  55. 55.
    Montoyo JV, Angel J, Valle V, Gausi C: Cardioversion of tachycardias by transesophageal atrial pacing. Am. J. Cardiol. 32: 85, 1973.PubMedCrossRefGoogle Scholar
  56. 56.
    Gallagher JJ, Smith WM, Kerr CR, Kasell J, Cook L, Reiter M, Sterba R, Harte M: Esophageal pacing: A diagnostic and therapeutic tool. Circulation 65: 336, 1982.PubMedCrossRefGoogle Scholar
  57. 57.
    Kerr CR, Gallagher JJ, Smith WM, Sterba R, German LD, Cook L, Kasell JH: The induction of atrial flutter and fibrillation and the termination of atrial flutter by esophageal pacing. PACE 6: 60, 1983.PubMedCrossRefGoogle Scholar
  58. 58.
    Shaw RJ, Berman LH, Hinton JM: Successful emergency transoesophageal cardiac pacing with subsequent endoscopy. Br. Med. J. 284: 309, 1982.CrossRefGoogle Scholar
  59. 59.
    Touborg P, Andersen HR, Pless P: Low-current bedside emergency atrial and ventricular cardiac pacing from the oesophagus. Lancet 1: 166, 1982.PubMedCrossRefGoogle Scholar
  60. 60.
    Cooper DN: Temporary cardiac pacing via the oesophagus. Postgrad. Med. J. 58: 45, 1982.PubMedCrossRefGoogle Scholar
  61. 61.
    Andersen HR and Pless P: Trans-esophageal pacing. PACE 6: 674, 1983.PubMedCrossRefGoogle Scholar
  62. 62.
    Binkley PF, Bush CA, Kolibash AJ, Magorien RD, Hamlin RL, Leier CV: The anatomic relationship of the esophageal lead to the left atrium. PACE 5: 853, 1982.PubMedCrossRefGoogle Scholar
  63. 63.
    Massumi RA, Sarin RK, Tawakkol AA, Rios JC, Jackson H: Time sequence of right and left atrial depolarization as a guide to the origin of the P waves. Am. J. Cardiol. 24: 28, 1969.PubMedCrossRefGoogle Scholar
  64. 64.
    Puech P: The P wave: Correlation of surface and intra-atrial electrograms. Cardiovasc. Clin. 6: 43, 1974.PubMedGoogle Scholar
  65. 65.
    Prystowsky EN, Pritchett ELC and Gallagher JJ: Origin of the atrial electrogram recorded from the esophagus. Circulation 61: 1017, 1980.PubMedGoogle Scholar
  66. 66.
    Ledley RS, Huang HK, Mazziotta JC: Cross-sectional Anatomy - An Atlas for Computerized Tomography. Williams & Wilkins: Baltimore, 1977.Google Scholar
  67. 67.
    Josephson ME and Seides SF: Clinical Cardiac Electrophysiology Techniques and Interpretations. Lea & Febiger: Philadelphia, 1979.Google Scholar
  68. 68.
    Bär FW, Brugada P, Dassen WRM, Wellens HJJ: Differential diagnosis of tachycardia with narrow QRS complex (shorter than 0.12 second). Am. J. Cardiol. 54: 555, 1984.PubMedCrossRefGoogle Scholar
  69. 69.
    Wu D, Denes P, Amat-Y-Leon F, Dhingra R, Wydham CRC, Bauernfeind R, Latif P, Rosen KM: Clinical electrocardiographic and electrophysiologic observations in patients with paroxysmal supraventricular tachycardia. Am. J. Cardiol. 41: 1045, 1978.PubMedCrossRefGoogle Scholar
  70. 70.
    Josephson ME: Paroxysmal supraventricular tachycardia: An electrophysiologic approach. Am. J. Cardiol. 41: 1123, 1978.PubMedCrossRefGoogle Scholar
  71. 71.
    Benson DW, Jr, Dunnigan A, Benditt DG, Pritzker MR, Thompson TR: Transesophageal study of infant supraventricular tachycardia: Electrophysiologic characteristics. Am. J. Cardiol. 52: 1002, 1983.PubMedCrossRefGoogle Scholar
  72. 72.
    Smith RF: The Wolff-Parkinson-White syndrome as an aviation risk. Circulation 29: 672, 1964.PubMedGoogle Scholar
  73. 73.
    Wellens HJ and Durrer D: Wolff-ParkinsonWhite syndrome and atrial fibrillation: Relation between refractory period of accessory pathway and ventricular rate during atrial fibrillation. Am. J. Cardiol. 34: 777, 1974.PubMedCrossRefGoogle Scholar
  74. 74.
    Castellanos A, Jr, Castillo CA, Agha AS, Befeler B, Myerburg RJ: Functional properties of accessory AV pathways during premature atrial stimulation. Br. Heart J. 35: 578, 1973.PubMedCrossRefGoogle Scholar
  75. 75.
    Castellanos A, Jr, Myerburg RJ, Craparo K, Befeler B, Agha AS: Factors regulating ventricular rates during atrial flutter and fibrillation in pre-excitation (Wolff-Parkinson-White) syndrome. Br. Heart J. 35: 811, 1973.PubMedCrossRefGoogle Scholar
  76. 76.
    Tonkin AM, Miller HC, Svenson RH, Wallace AG, Gallagher JJ: Refractory periods of the accessory pathway in the Wolff-ParkinsonWhite syndrome. Circulation 52: 563, 1975.PubMedGoogle Scholar
  77. 77.
    Critelli G, Grassi G, Perticone F, Coltorti F, Monda V, Condorelli M: Transesophageal pacing for prognostic evaluation of preexcitation syndrome and assessment of protective therapy. Am. J. Cardiol. 51: 513, 1983.PubMedCrossRefGoogle Scholar
  78. 78.
    Wellens HJJ and Brugada P: Value of programmed stimulation of the heart in patients with Wolff-Parkinson-White syndrome. In Tachycardiac: Mechanisms, Diagnosis, Treatment. ME Josephson and HJJ Wellens (eds.). Lea & Febiger: Philadelphia, 1984.Google Scholar
  79. 79.
    Wellens HJJ, Bar FW, Farre J, Ross D, Vanagt EJ: Sudden death in the Wolff-Parkinson-White syndrome. In Sudden Death. HE Kulbertus and HJJ Wellens (eds.). Martinus Nijhoff: Boston, 1980.Google Scholar
  80. 80.
    Lévy S, Broustet JP, Clementy J, Guern B, Vircoulon B, Guern P, Bricaud H: Syndrome de Wolff-Parkinson-White: Correlations entre l’exploration electrophysiologique et l’effet de l’epreuve d’effort sur l’aspect electrocardiographique de preexcitation. Arch. Mal Coeur 72: 634, 1979.PubMedGoogle Scholar
  81. 81.
    Wellens HJJ, Bar FW, Gorgels AP, Vanagt EJ: Use of ajmaline in patients with the WolffParkinson-White syndrome to discover short refractory period of the accessory pathway. Am. J. Cardiol. 45: 130, 1980.PubMedCrossRefGoogle Scholar
  82. 82.
    Benson DW, Jr, Dunnigan A, Benditt DG, Pritzker HR: Transesophageal conversion of atrial flutter in infants, children and young adults. (Abstract.) Circulation 66: II - 316, 1982.Google Scholar
  83. 83.
    Dunnigan A, Benson DW, Jr, Benditt DG: Atrial flutter in infancy: Diagnosis, clinical features, and treatment, Pediatrics 75: 725, 1985.PubMedGoogle Scholar
  84. 84.
    Disertori M, Inama G, Vergara G, Guarnerio M, Furlanello F: Impiego della stimolazione atriale transesofagea nel trattamento del flutter atriale. G. Ital. Cardiol. 14: 153, 1984.Google Scholar
  85. 85.
    Brody DA, Harris TR, Romans WE: A simple method for obtaining esophageal electrocardiograms of good diagnostic quality. Am. Heart J. 50: 923, 1955.PubMedCrossRefGoogle Scholar
  86. 86.
    Brody DA and Copeland GD: The principles of esophageal electrocardiography. Am. Heart J. 57: 3, 1959.PubMedCrossRefGoogle Scholar
  87. 87.
    Copeland GD, Tullis IF, Brody DA: Clinical evaluation of a new esophageal electrode, with particular reference to the bipolar esophageal electrocardiogram: Part I. Normal sinus mechanism. Am. Heart J. 57: 862, 1959.PubMedCrossRefGoogle Scholar
  88. 88.
    Barold SS: Filtered bipolar esophageal electrocardiography. Am. Heart J. 83: 431, 1972.PubMedCrossRefGoogle Scholar
  89. 89.
    Benson DW, Jr, Sanford M, Dunnigan A, Benditt DG: Transesophageal atrial pacing threshold: Role of interelectrode spacing, pulse width and catheter insertion depth. Am. J. Cardiol. 53: 63, 1984.PubMedCrossRefGoogle Scholar

Copyright information

© Martinus Nijhoff Publishing 1986

Authors and Affiliations

  • David C. Chung
  • Charles R. Kerr

There are no affiliations available

Personalised recommendations