Device and methods for performing transesophageal stimulation at reduced pacing current threshold

In order to reduce pacing current threshold in transesophageal stimulation, a novel multichannel transesophageal pacemaker and multichannel esophageal lead has been developed. Three different approaches to reduce pacing current threshold were clinically studied. Precise positioning of the pacing dipole allowed reduction of pacing current threshold on average by 20% over the standard bipolar transesophageal method in approximately 50% of patients. Use of a chest electrode lowered pacing current by up to 7 mA over standard bipolar transesophageal method in 60% of patients. A novel method of combining very short electrical pulses (splitting the impulse) from different locations, which gives desired current density and pulse length in the target tissue, has been elaborated. As a result, the stimulation is less painful for the patient than the routinely used single 10 ms current pulse. The proposed methods allowed successful atrial capture in all patients.