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[Evaluation of the left ventricular function in patients with coronary disease by means of atrial pacing]
Insights
Rapid atrial pacing reveals abnormal left ventricular function in coronary artery disease patients, distinguishing transient ischemic dysfunction from chronic issues, aiding surgical decisions.
Area of Science:
- Cardiology
- Physiology
Context:
- Assessing left ventricular function in coronary artery disease (CAD) is crucial.
- Standard angiography may not reveal functional deficits at rest.
- Rapid atrial pacing offers a method to stress the heart and uncover abnormalities.
Purpose:
- To evaluate left ventricular function during stress in CAD patients using rapid atrial pacing.
- To differentiate between resting and stress-induced myocardial dysfunction.
- To investigate the hemodynamic effects of pacing in relation to angiographic findings.
Summary:
- Rapid atrial pacing was performed on 18 CAD patients and 12 controls.
- Left ventricular function during pacing was compared to resting cardiac dynamics and angiograms.
- Pacing revealed dysfunction not apparent at rest and distinguished transient ischemic effects from chronic dysfunction.
Impact:
- Rapid atrial pacing can unmask latent left ventricular dysfunction in CAD.
- This technique helps differentiate transient anginal dysfunction from chronic preanginal dysfunction.
- Findings may inform surgical revascularization strategies for CAD patients.
Abstract:
In 18 patients with coronary artery disease and in 12 control subjects, left ventricular function was studied by means of rapid artial pacing. The results were compared with the cardiac dynamics, as determined by left ventricular dysfunction although the angiograms portrayed normal contractility at rest. It has to be assumed, that abnormal myocardial function was only evident during the pacing stress. On the other hand, if the angiogram showed local hypokinesis, the hemodynamic effect of this slightly abnormal contraction could be determined by atrial pacing. Moreover, rapid atrial pacing often produced myocardial ischemia and anginal pain in patients with coronary heart disease. In these cases the transient "anginal" depression of left ventricular function could be separated from the chronic hypoxic "preanginal" dysfunction. This may be of vale in terms of surgical revascularisation.