Introduction: The purpose of this study was to evaluate termination of atrial flutter (AFL) by directed rapid transesophageal atrial pacing (TAP) with and without simultaneous transesophageal echocardiography (TEE) performed using a novel TEE tube electrode. Materials and methods, and Results: A total of 16 AFL patients (age 63"12 years; 13 males) with mean AFL cycle length of 224"24 ms (ns12) and mean ventricular cycle length of 448"47 ms (ns12) were analyzed using either an esophageal TO electrode (ns10) or a novel TEE tube electrode consisting of a tube with four hemispherical electrodes that is pulled over the echo probe (ns6). AFL could be terminated by directed rapid TAP using an esophageal TO electrode, leading to induction of atrial fibrillation (AF) (ns6), induction of AF and spontaneous conversion to sinus rhythm (SR) (ns3), and with conversion to SR (ns1). AFL could also be terminated by directed rapid TAP using the TEE tube electrode, with induction of AF (ns3) or induction of AF and pontaneous conversion to SR (ns3). Conclusion: AFL can be terminated by directed rapid TAP with hemispherical electrodes with and without simultaneous TEE. TAP with the directed TEE tube electrode is a safe, simple, and useful method for terminating AFL.
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