Update 1991 pp 34-43 | Cite as

Cardioversion and Defibrillation: The Esophageal Approach

  • A. A. J. Adgey
  • P. P. McKeown
  • J. McC Anderson
Conference paper
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 14)


Trans-chest cardioversion and defibrillation are procedures of low efficiency as only a small fraction of the delivered energy actually passes through the heart. In an attempt to utilize the close anatomical relationship between the heart and the esophagus, we have designed a stable esophageal system which consists of four separate electrodes, each of coiled gold-plated copper wire, mounted on PVC tubing — external diameter ranges from 5–9 mm. We have investigated the use of this electrode system in cardioversion of stable atrial and ventricular tachyarrhythmias. In addition, the esophageal system has also been electively positioned in patients during electrophysiological studies to assess the potential for countershock of sustained ventricular arrhythmias induced during programed ventricular stimulation, in particular ventricular fibrillation. The potential for transesophageal cardiac pacing has also been explored.


Atrial Fibrillation Ventricular Fibrillation Rheumatic Heart Disease Esophageal Injury Transthoracic Impedance 
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.


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  1. 1.
    Geddes LA, Tacker WA, Schoenlein W, Minton M, Grubbs S, Wilcox P (1976) The prediction of the impedance of the thorax to defibrillation current. Med Inst 10:159–162Google Scholar
  2. 2.
    Dalzell GWN, Magee H, Anderson J, Adgey AAJ (1986) Predicted and actual impedances in cardioversion. Circulation 74 (Suppl II): 388Google Scholar
  3. 3.
    Cremer M (1906) Über die direkte Ableitung der Aktionsströme des menschlichen Herzens vom Oesophagus und Über das Elektrokardiogramm des Fötus. München Med Wochenschr 53:811–813Google Scholar
  4. 4.
    Brown WH (1936) A study of the oesophageal lead in clinical electrocardiography. Part 1 — The application of the oesophageal lead in the human subject with observations in the Ta wave, extrasystoles and bundle-branch block. Am Heart J 12:1–45CrossRefGoogle Scholar
  5. 5.
    Arzbaecher R (1978) A pill electrode for the study of cardiac arrhythmias. Med Inst 12 (5):277–281Google Scholar
  6. 6.
    Shafiroff BGP, Linder J (1957) Effects of external electrical pacemaker stimuli on the human heart. J Thorac Surg 33:544–550PubMedGoogle Scholar
  7. 7.
    Gallagher JJ, Smith WM, Kerr CR, et al. (1982) Esophageal pacing: A diagnostic and therapeutic tool. Circulation 65: 336–341PubMedCrossRefGoogle Scholar
  8. 8.
    Benson DW, Dunnigan A, Benditt DG, Schneider SP (1984) Transesophageal cardiac pacing: History, application, technique. Clin Prog Pacing Electrophysiol 2:360–372Google Scholar
  9. 9.
    Burack B, Furman S (1969) Transesophageal cardiac pacing. Am J Cardiol 23:469–472PubMedCrossRefGoogle Scholar
  10. 10.
    Lubell DL (1971) Cardiac pacing from the oesophagus. Am J Cardiol 27:641–644PubMedCrossRefGoogle Scholar
  11. 11.
    Andersen HR, Pless P (1983) Transesophageal pacing. Pace 6:674–679PubMedGoogle Scholar
  12. 12.
    Roelandt JR, Sutherland GR (1988) Oesophageal echocardiography. Br Heart J 60:1–3PubMedCrossRefGoogle Scholar
  13. 13.
    Whipple GW, Penton GB (1956) Transoesophageal ventricular defibrillation. Clin Res Proc 4:105Google Scholar
  14. 14.
    McNally EM, Meyer EC, Langendorf R (1966) Elective countershock in unanesthetized patients with use of an esophageal electrode. Circulation 23:124–127Google Scholar
  15. 15.
    Fields J, Shachtman J, Craig SD, Berkovits BV, Roger A (1967) Special electrode device for trans-esophageal cardioversion. Proc 7th Int Conf on Medical and Biological Engineering, Sweden: 2/14 (abstract)Google Scholar
  16. 16.
    Lukoseviciute AJ, Peculiene IR (1980) Transesophageal cardioversion of resistant atrial arrhythmias. Resuscitation 8:159–165PubMedCrossRefGoogle Scholar
  17. 17.
    Don Michael TA (1986) The role of the esophageal obturator airway in cardiopulmonary resuscitation. Circulation 74 (IV): 134–137Google Scholar

Copyright information

© Springer-Verlag Berlin, Heidelberg 1991

Authors and Affiliations

  • A. A. J. Adgey
  • P. P. McKeown
  • J. McC Anderson

There are no affiliations available

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