[Stress echography and pacemakers]

The non-invasive investigation of myocardial ischaemia in pacemaker patients is a common problem. Stress echocardiography seems interesting for this indication, but very few data are available for patients fitted with a pacemaker. We wanted to know whether it would be useful to propose a conventional stress echography, under dobutamine/atropine, for these patients. One hundred stress echographies were performed at our centre between 1998 and 2004 in 113 consecutive ventricular paced patients at rest. We determined the degree of contraction asynchrony related to ventricular pacing and its impact on the interpretation of the test. In this series, the test proved contributory in 87% of cases, with disturbance of the target heart rate in 71% of cases, and contraction asynchrony hindering interpretation in only 11% of cases. Under the effect of the dobutamine/atropine combination, we observed passage into spontaneous rhythm in 54% of cases, with complete disappearance of septal asynchrony, thus facilitating interpretation of the test. It would therefore appear that conventional stress echography is the method of choice for the non-invasive investigation of myocardial ischaemia in patients fitted with a pacemaker, being well tolerated and contributory most of the time.