Transesophageal Atrial Pacing during Echocardiography Exams

High feasibility and excellent safety of the Echo pacing stress test on a large series of patients with known or suspected coronary artery disease.

Gallo A., Anselmi M., Golia G., Gaspari MG, Marino P, Vitolo A, Zardini P, University of Verona, Verona Italy. Abstract 1530, 1997 American Heart Assoc. The accuracy of the transesophageal echo-pacing test (EP) in the detection of coronary artery disease has been demostrated; however, its safety has not been investigated in large series of patients (pts). Methods: we evaluated our 6 year experience in 902 EP perforrned on 874 pts (707 males, age 58 +/- 9 years). Indications to EP were: evaluation of chest pain (42%), risk stratification after myocardial infarction (51%) and miscellaneous (7%). Regional wall motion abnormalities (WMA) were present at baseline in 62% of pts. EP were started at 110 beats/min and increased every 2 minutes by 10 beats/min. Results: EP was not feasible in 24 tests (3%), due to intolerance of the patient (11) or to impossibility to obtain a stable atrial capture (13). It was diagnostic in 838 (93%) tests (achieved 85% of the maximum predicted heart rate in 784, early appearance of large WMA in 54). EP was prematurely interrupted and not diagnostic in 40 (4%) tests because of second degree AV block type I resistant to administration of atropine 1 mg i.v. (34), hypertension (2), hypotension (2) and arrhythmias (2). Ischemia (either WMA or ST segment depression) developed in 289 tests (33%). There were no major complications (death, myocardial infarction, life-threatening arrhythmias). Minor complications (15) were: transient arrhythmias [3 atrial fibrillation, 4 PSVT, 2 atrial ectopic rhythm, 1 sinus arrest (6 sec), 3 nonsustained ventricular tachycardia (max 6 beats)], 1 mild heart failure secondary to ischemia requiring i.v. diuretics and 1 epistaxis. Conclusion: EP appears a high feasible and very safe test in the evaluation of pts with coronary artery disease. Its safety should be considered in comparison with pharmacological stressors, that have higher potential risk.

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