Feasibility and safety of transesophageal stress echocardiography

To determine the feasibility and safety of transesophageal stress echocardiography (TSE), 86 patients with chest pain syndrome were studied. The TSE test consists of transesophageal atrial pacing during simultaneous monitoring of left ventricular contractility by the use of transesophageal echocardiography. An octapolar pacing catheter attached to the transesophageal echoscope was used in conjunction with a cardiac stimulator to induce pacing-tachycardia. The optimal pair of electrodes was chosen from 13 possible combinations of the 8-electrode catheter. The pacing rate was increased until greater than or equal to 90% maximal age-predicted heart rate was reached or significant wall motion abnormalities were developed. The test was also stopped if ischemic electrocardiographic changes or progressive chest pain occurred. A successful TSE test was performed on 77 patients (90%). Twenty-one patients (24%) developed Wenckebach AV block during pacing that was resolved by intravenous atropine sulfate in all but one of them. The TSE test could not be completed in nine patients (10%) because we were unable to capture in four patients (5%), there were suboptimal images in three patients (3%), and two patients suffered intolerable epigastric discomfort (2%). Pacing-induced wall motion abnormalities were identified in 53 patients (69%). No serious complications were noted. We conclude that TSE is a feasible nonexercise stress test that can be performed safely in patients with suspected coronary artery disease.