Abstract OBJECTIVE To investigate the effect and safety of esophageal atrial pacing (TEAP) in the treatment of paroxysmal supraventricular tachycardia (PSVT), and to compare it with propafenone. Methods: 92 cases of PSVT were randomly divided into TEAP group (group A) and propafenone intravenous group (group B), 46 cases in each group. Results The success rate of conversion was significantly higher in the TEAP group than in the propafenone group (95.6% compared with 63%, P<0.01), and side effects such as sinus bradycardia, sinus arrest, atrioventricular block, and hypotension occurred in the propafenone group. Conclusion: TEAP is significantly more effective and safer than propafenone in the treatment of PSVT, and it is worth promoting its application. Paroxysmal supraventricular tachycardia (PSVT) is a common arrhythmia characterized by sudden onset and abrupt termination, which commonly occurs in normal subjects without obvious heart disease, but also in various organic heart diseases. The purpose of this paper is to compare the effectiveness and safety of these two treatment methods and to explore the value of TEAP in the treatment of paroxysmal supraventricular tachycardia (PSVT). 1. Data and Methods 1.1 General Data 92 cases of outpatients and inpatients of cardiovascular medicine in our hospital from 2001 to 2006 were used. All cases were confirmed as PSVT by conventional ECG and esophageal lead ECG, including 44 cases of AVNRT, 47 cases of AVRT and 1 case of IART. There were 52 male and 40 female cases, aged 22-70 years, mean 46.5 years, including 62 cases without organic heart disease, 4 cases of stable angina pectoris with coronary artery disease, 1 case of unstable angina pectoris, 19 cases of asymptomatic myocardial ischemia, 2 cases of hypercardia, 1 case of senile heart valve disease, 1 case of precordial heart disease (atrial septal defect), 1 case of hyperthyroid heart, and 1 case of dilated cardiomyopathy. The average heart rate at the onset of tachycardia was 166 beats/min, blood pressure was 116/75 mmHg, the average history of supraventricular tachycardia was 4.5 years, and the average time between onset and consultation was 56 min. 1.2 Methods: The patients were randomly divided into TEAP group and propafenone group according to the serial number of consultation. In 46 cases of propafenone group, protective esophageal pacing electrodes were placed before the drug was administered. 70mg of propafenone was injected intravenously for the first dose, and for those who could not be converted to rhythm, 70mg was injected again at an interval of 10min. 210mg was the total dose, and conversion to sinus rhythm within 2h was considered effective. Firstly, the atria were paced for 3-5 s at a rate 30-50 beats/min faster than the rate of supraventricular tachycardia, and then repeated once if it was ineffective, and if it was still ineffective, the atria were paced for 5-5 s at a rate 40% faster than the rate of tachycardia by using the short burst stimulation method. If still ineffective, short burst stimulation is applied, using a frequency of about 40% faster than tachycardia to deliver 5-10 bursts of stimulation, which can be repeated 2 times [1]. Those who could not be terminated by either TEAP method were switched to propafenone 70 mg-210 mg intravenously to terminate the attack. Routine ECG and esophageal lead ECG were performed before and after resuscitation in all patients, and ECG monitoring and blood pressure monitoring were performed during resuscitation. The two groups of patients were comparable in terms of gender, age, length of medical history, heart rate during PSVT episodes, blood pressure and underlying cardiac changes. 1.3 Statistical treatment: χ2 test was performed to compare the difference between the two groups in terms of successful conversion rate. 2. Results: 29 patients in the intravenous propafenone group were successfully converted, with a success rate of 63%. The mean dose of propafenone was 110 mg, and 7 patients (24%) aged over 50 years experienced significant side effects, including 2 cases of sinus arrest at the termination of supraventricular tachycardia, which resumed sinus rhythm after timely pacing, 2 patients experienced significant sinus bradycardia after conversion (heart rate 33-46 beats /The main side effects were burning and tingling sensation behind the sternum, and one patient had a successful conversion to TEAP. The main side effects were retrosternal burning sensation, tingling sensation, one patient stopped the operation because he could not tolerate this side effect, and one case of ineffective pacing, which was converted to sinus rhythm 39 min after applying propafenone 140 mg by sedation. The above results were subjected to χ2 test, χ2=15.6>X20.01(1)=6.63, P<0.01, and the difference in success rate between the two groups was significant. 3, Discussion Propafenone mainly terminates PSVT by slowing conduction and slightly prolonging the action potential time course, blocking the retrograde conduction of the fast path in the dual pathway of the AV node, and prolonging the atrioventricular bypass nonresponse period, with a reversal rate of 55% to 85%. In this paper, PSVT was terminated by intravenous administration of propafenone with a success rate of 63%, similar to that reported in the literature. 7 patients older than 50 years of age developed significant sinus bradycardia, AV block, and hypotension after administration of the drug, which was analyzed as a result of the negative inotropic and negative frequency side effects of propafenone. Propafenone inhibits myocardial contractility. Propafenone has little effect on normal sinus node and atrioventricular node function, but elderly people often have underlying lesions or poor function of the sinus node and atrioventricular node, so it can cause significant inhibition of sinus node and atrioventricular node function when used in high doses [2]. In contrast, TEAP has a high success rate in terminating PSVT, with a significant difference compared to intravenous propafenone and no significant side effects, especially in elderly people with hypotension, cardiac insufficiency, bradycardia, and myocardial ischemia, which shows the advantages of TEAP. Therefore, some authors [3] concluded that TEAP should be the preferred method to terminate supraventricular tachycardia in the elderly, with mild side effects, mainly burning sensation behind the sternum due to stimulation of the esophageal wall by electrical impulses, which is generally tolerable. From the comparison of the two groups, it can be seen that the side effects caused by transient propafenone transient rhythm are large, while TEAP termination of PSVT is fast-acting and has a high success rate, taking only about 20 min from intubation to termination, and if there is a >3s long interval, the pacing key can be pressed urgently to issue electrical pulses to pace the atria to prevent untoward events. In some patients with pathological sinus node syndrome, the application of antiarrhythmic drugs is quite tricky during episodes of supraventricular tachycardia, where the tachycardia is likely to terminate, but the negative frequency effect of antiarrhythmic drugs can inhibit the sinus node, and untimely pacing can lead to accidents, while many primary hospitals do not have cardiac pacing technology [4]. We put protective esophageal electrodes in all cases, which not only allows diagnosis of tachycardia by esophageal ECG, but also allows indirect pacing of the atria by pacing electrical pulses if there are long intervals after termination of tachycardia, and if tachycardia suppression is unsuccessful, antiarrhythmic drugs can be used without fear of suppressing the sinus node to occur long intervals, thus ensuring the safety of treatment. Thus, the application of TEAP for the treatment of paroxysmal supraventricular tachycardia has the advantages of being safe, efficient, fast, and easy to perform, and the author believes that it is worth promoting the application of radiofrequency ablation in the majority of primary hospitals that are not yet in a position to perform it.