What is the role of programmable stimulation in the treatment of pediatric atrial flutter?

Updated: Feb 04, 2019
  • Author: M Silvana Horenstein, MD; Chief Editor: Syamasundar Rao Patnana, MD  more...
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Answer

Pace-termination of atrial flutter is best performed with a programmable stimulator that is capable of sensing atrial electrograms and delivering single, double, or multiple extrastimuli at adequate output and individually programmable cycle lengths down to 100 milliseconds.

Short discrete ramps or bursts of atrial stimuli are the most likely to produce a type I conversion of atrial flutter (immediate conversion to sinus rhythm), particularly if they can be delivered in or near the flutter circuit. If such a device is unavailable, a pacemaker capable of burst pacing at a specified rate may be used.

If pacing is performed via an esophageal electrode, the device should be capable of delivering stimuli at pulse widths of 9.9-20 milliseconds and outputs of 10-26 mA.

Patients who are treated with atrial antitachycardia pacing should undergo testing to confirm that their device is effective and not proarrhythmic.


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