Effects of catheter shape, interelectrode spacing, and electrode size on transesophageal atrial pacing in dogs.

OBJECTIVE: To determine effects of catheter shape, interelectrode spacing (IS), and electrode size (ES) on pacing threshold (PT), extraneous muscular stimulation (EMS), and zone of capture (ZOC) for dogs undergoing transesophageal atrial pacing (TAP). ANIMALS: 10 purpose-bred dogs without cardiac conduction disturbances. PROCEDURES: 7 configurations for TAP catheters were tested in each dog to evaluate effects of catheter shape (curved or straight), IS (5, 15, and 25 mm), and ES (2, 4, and 6 mm). Each catheter was passed into the esophagus to a location aboral to the heart and slowly withdrawn until atrial pacing was achieved. Then, catheters were withdrawn in 5-mm increments until pacing could not be achieved. Outcomes measured at each pacing site included PT, degree of EMS, and ZOC. RESULTS: There was a significantly lower PT, wider ZOC, and less EMS for the curved catheter than for the straight catheter. An ES of 6 mm induced significantly more EMS than was induced by an ES of 2 or 4 mm. An IS of 5 mm induced significantly less EMS and a significantly narrower ZOC but required a significantly higher PT, compared with results for an ES of 15 or 25 mm. Additionally, there was a significant direct correlation between IS and ZOC. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that a curved catheter with multiple 4-mm electrodes that provides for variable IS would be ideal for TAP in dogs. IMPACT FOR HUMAN MEDICINE: TAP catheters currently used in human medicine are straight. The PT in humans may potentially be reduced with curved catheters.