Premium
Identifying Patients for Rate Responsive Atrial Pacing: A New Method for Patient Selection and Pacemaker Programming
Author(s) -
COCK CAREL C.,
KAMP O.,
MEIJER A.
Publication year - 1992
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1992.tb02970.x
Subject(s) - medicine , cardiology , coronary artery disease , cardiac pacing
In patients with sinus node disease (SND) and chronotropic incompetence, atrial rate adaptive stimulation (AAI, R pacing) is regarded as the most appropriate pacing mode. Since coronary artery disease is the most common etiology in these patients, we evaluated a new technique combining two‐dimensional transesophageal echocardiography and atrial transesophageal pacing to detect pacing induced wall motion abnormalities and assess safe upper rate limits. Thirty‐five patients were studied; 26 with and 9 without angiographic coronary artery disease. Stable atrial capture was achieved in all patients using 12 ± 3 msec pulse width and 12 ± 4 mA current strength. Sensitivity and specificity for the detection of coronary artery disease was highest for transesophageal echocardiography during pacing (sensitivity 81%, specificity 100%). Simultaneous 12‐lead ECG during pacing had lower values (sensitivity 57%, specificity 75%). Pacing induced wall motion abnormalities preceded ST segment changes in all patients. Exercise stress testing showed similar values (sensitivity 62%, specificity 89%), It is concluded that simultaneous transesophageal echocardiography and transesophageal pacing is a safe and useful technique in selecting patients for AAI, R pacing and for the detection of safe upper rate limits, particularly when coronary artery disease is suspected.