PEDIATRICS Vol. 75 No. 4 April 1985, pp. 730-736
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Atrial Overdrive Pacing for Conversion of Atrial Flutter in Children

Robert M. Campbell MD1, Macdonald Dick II MD1, Janice M. Jenkins PhD1, Robert L. Spicer MD1, Dennis C. Crowley MD1, Albert P. Rocchini MD1, A. Rebecca Snider MD1, Aaron M. Stern MD1, and Amnon Rosenthal MD1

1 From the Division of Pediatric Cardiology, C. S. Mott Children's Hospital, and Department of Pediatrics and Department of Electrical and Computer Engineering, University of Michigan Ann Arbor

Twenty-three successive patients with 27 different episodes of sustained atrial flutter were treated with atrial pacing for conversion of the tachyarrhythmia; 15 patients with 16 episodes of atrial flutter underwent intracardiac right atrial pacing and eight patients with 11 episodes of atrial flutter were treated with transesophageal atrial pacing. Ten of sixteen episodes (63%) and eight of 11 episodes (73%) were successfully converted using intracardiac and transesophageal techniques, respectively. Mean flutter cycle length for all 27 episodes was 219 ms (mean heart rate 274 beats per minute); successful pacing conversion cycle length (n = 15) was 72% of the flutter cycle length. Hemodynamic, electrophysiologic, and roentgenographic data were not predictive of conversion by either technique. Induction of localized atrial fibrillation or failure to meet critical pacing criteria may explain pacing failures. Based on this experience, a trial of transesophageal atrial pacing for acute conversion of any episode of atrial flutter in children prior to direct current cardioversion is recommended.

Key Words: arrhythmia • atrial flutter • pacing • transesophageal atrial pacing

Submitted on March 19, 1984
Accepted on June 11, 1984




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