Salas Nieto J, Lopez Candel J, Villegas Garcia M, Garcia Garcia J, de la Morena Valenzuela G, Pico Aracil F, Campos Peris JV, Ruiperez Abizanda JA. Hospital Universitario Virgen de la Arrixaca, Murcia. Rev Esp Cardiol 1994 May;47(5):308-15. INTRODUCTION AND OBJECTIVES. Atrial pacing has been proposed as an alternative method to the isotonic exercise, to induce ischemia, and, joined to two-dimensional echocardiography, as one of the main modalities in stress echo. In order to analyse its applicability and diagnostic value in assessing coronary artery disease this study was undertaken. PATIENTS AND METHODS. 52 patients referred to coronarography for suspicion or evaluation of ischemic disease, were submitted to this technique. RESULTS. The study was completed in 44 patients (applicability rate of 84,7%). The results obtained showed a sensitivity, specificity and diagnostic accuracy for the regional wall motion abnormalities echocardiographically detected, of 88%, 68% and 79%, respectively. When electrocardiographic changes or presence of angina during atrial pacing were added to echocardiographic data, sensitivity increased to 96%. In 41 patients in which a conventional stress test was available, sensitivity was 55% electrocardiographically, 33% clinically and 68% globally. CONCLUSIONS. It is concluded that transthoracic two-dimensional echocardiography during atrial pacing is a safe, highly sensitive method for coronary artery disease detection. The limitations of the method for its routine clinical application are also analysed.