To the Editor

I have followed this exchange of opinions with great interest, aware that most likely those raising issues with beta blockade as a “standard of care” are influenced by similar strong statements about the early use of PA catheters. The letter from Dr. Royster omitted, I believe, an easy solution to the problem of a bit too much beta blockade: transesophageal atrial pacing. There is a TAPSCOPE in the OR where I work, and when it is employed, it solves the heart-rate-of-<50 problem with great predictability, unlike the variable results with atropine and friends. The initial cost is of course much higher but so is the probability of success. I have no connection with the company that makes the pacing device (CardioCommand, Inc. – www.cardiocommand.com) and receive no compensation from them.

C.F. Ward, MD
San Diego, CA