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Right atrial pacing for risk stratification in patients with angina pectoris
1Department of Medicine, Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
Insights
Right atrial pacing (RAP) can predict coronary artery disease (CAD) severity and future cardiac events. Positive RAP indicates higher risk, with significant increases in left ventricular end-diastolic pressure and major cardiac events.
Area of Science:
- Cardiology
- Clinical Medicine
- Diagnostic Procedures
Background:
- Coronary artery disease (CAD) assessment often uses right atrial pacing (RAP) to evaluate myocardial ischemia.
- Clinical significance of RAP markers for predicting CAD severity and patient outcomes remains unclear.
Purpose of the Study:
- To determine if three-stage RAP can predict CAD severity.
- To evaluate RAP's ability to forecast major cardiac events (MCE) in patients with chest pain.
Main Methods:
- 49 patients with typical chest pain underwent three-stage RAP.
- RAP was positive if ≥1 mm horizontal or downward ST depression occurred.
- Hemodynamic data, including left ventricular end-diastolic pressure (LVEDP), were analyzed.
Main Results:
- Positive RAP (28 patients) correlated with significantly increased LVEDP post-pacing (p < 0.05).
- Positive RAP group showed higher incidence of multivessel disease (p < 0.001) and lower incidence of non-significant CAD (p < 0.001).
- Positive RAP group experienced significantly more MCE during 2-year follow-up (23 vs. 2, p < 0.005).
Conclusions:
- Three-stage RAP is a valuable tool for predicting CAD severity.
- Positive RAP predicts a higher likelihood of future major cardiac events.
- RAP's ability to identify high-risk patients warrants further clinical consideration.
Abstract:
Right atrial pacing (RAP) has been used to assess the physiologic impact of coronary artery disease (CAD). Several variables have served as markers of pacing-induced myocardial ischemia or for predicting disease severity, but their clinical implications remain uncertain. Therefore, three-stage RAP was performed to evaluate whether this strategy could predict the disease severity of CAD and foretell subsequent major cardiac events in 49 patients with typical chest pain. RAP was considered positive if 1 mm or more of horizontal or downward ST depression developed. Of the 49 cases, 28 had positive RAP (group A), and the remaining 21 had negative RAP (group B). For hemodynamic data, early positive RAP had the highest post-pacing left ventricular end-diastolic pressure (LVEDP). The LVEDP increased significantly in Group A (p < 0.05), whereas there was no apparent change in group B. Furthermore, group A (36%) tended to develop typical chest pain more easily than group B (14%), but this was statistically insignificant. Group A had a higher incidence of multivessel disease than that of group B (p < 0.001), whereas group A had a lower incidence of non-significant CAD than that of group B (p < 0.001). During the mean two-year follow-up period, there were 23 major cardiac events (MCE) in group A in contrast to two episodes in group B (p < 0.005). The early positive subset had 18 episodes, whereas the late positive subset had only five episodes (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)