BACKGROUND Transesophageal atrial pacing (TAP) has been successfully applied for clinical use for more than 30 years. Not only for cardiac pacing, or diagnosis and treatment of rhythmic disturbance but also for assessing the presence and severity of coronary artery disease and maintaining adequate heart rate can TAP provide satisfactory effect. In this study we applied TAP on children undergoing the cardiac surgery to evaluate its efficacy and side effects during such major surgery. METHODS Twenty-four children (15 M and 9 F) undergoing open-heart surgery with informed consents were included in this study. After induction of anesthesia the bipolar pacing electrode (Tapcath, Arzco Medical Electronics) was inserted into esophagus through the nose until the ideal site for atrial pacing was found by monitoring the esophageal ECG lead (lead I), and then initiation of atrial pacing was performed by applying the transesophageal cardiac stimulator (Arzco Medical Electronics). Continuous ECG, arterial blood pressure and central venous pressure (CVP) were simultaneously monitored and recorded. Patient's height, inserted length of the pacing electrode, current and pulse duration for effective atrial pacing were also recorded. RESULTS The effective rate for initiating sinus tachycardia (atrial capture) by applying TAP was 79.2% (19/24) in our study. For effective atrial pacing the average current was 11.6 +/- 2.4 mA, the average stimulus pulse duration was 4.8 +/- 1.0 ms, and the average inserted length of bipolar electrode was 19.1 +/- 2.2 cm. CONCLUSIONS TAP method can be applied satisfactorily in children undergoing cardiac surgery. If urgent cardiac pacing must be applied in these patients TAP would be a choice.