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Related Experiment Videos

Identifying patients for rate responsive atrial pacing: a new method for patient selection and pacemaker programming.

C C de Cock1, O Kamp, A Meijer

  • 1Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands.

Pacing and Clinical Electrophysiology : PACE
|November 1, 1992
PubMed
Summary

Transesophageal echocardiography combined with atrial pacing safely detects coronary artery disease and determines safe upper pacing rates for sinus node disease patients. This method identifies pacing-induced wall motion abnormalities before ECG changes occur.

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Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Diagnostic Imaging

Background:

  • Sinus node disease (SND) with chronotropic incompetence often requires atrial rate-adaptive pacing (AAI,R).
  • Coronary artery disease (CAD) is a frequent comorbidity in these patients.
  • Assessing safe upper pacing rates and detecting underlying CAD is crucial for optimal AAI,R therapy.

Purpose of the Study:

  • To evaluate a novel technique combining 2D transesophageal echocardiography (TEE) and atrial transesophageal pacing.
  • To assess the ability of this technique to detect pacing-induced wall motion abnormalities (WMA).
  • To determine safe upper rate limits for AAI,R pacing in patients with suspected CAD.

Main Methods:

  • Thirty-five patients with SND were studied, including 26 with confirmed CAD.

Related Experiment Videos

  • TEE was performed simultaneously with atrial transesophageal pacing to assess WMA.
  • Sensitivity and specificity of TEE during pacing were compared with 12-lead ECG and exercise stress testing for CAD detection.

    • Main Results:

    • Stable atrial capture was achieved in all patients.
    • TEE during pacing demonstrated high sensitivity (81%) and specificity (100%) for detecting CAD.
    • Pacing-induced WMAs consistently preceded ST-segment changes on ECG.
    • Exercise stress testing showed lower sensitivity (62%) and specificity (89%) compared to TEE.

    Conclusions:

    • Simultaneous TEE and transesophageal pacing is a safe and effective method.
    • This technique is valuable for selecting appropriate patients for AAI,R pacing.
    • It aids in identifying safe upper pacing rate limits, especially in patients with suspected CAD.