This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lee, C.-Y. Articles by Seward, J. B. Search for Related Content PubMed PubMed Citation Articles by Lee, C.-Y. Articles by Seward, J. B.

CLINICAL STUDIES

Nonexercise stress transthoracic echocardiography: transesophageal atrial pacing versus dobutamine stress

Chung-Yin Lee, MB, BS, MMed^*, Patricia A. Pellikka, MD, FACC^*, Robert B. McCully, MD, FACC^*, Douglas W. Mahoney, MSc and James B. Seward, MD, FACC^*

^* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

Manuscript received May 28, 1998; revised manuscript received September 16, 1998, accepted October 26, 1998.

Reprint requests and correspondence: Dr. Patricia A. Pellikka, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
pellikka.patricia{at}mayo.edu

Objectives

To compare transesophageal atrial pacing stress echocardiography with dobutamine stress echocardiography for feasibility, safety, duration, patient acceptance and concordance in inducing wall motion abnormalities.

Background

Transesophageal atrial pacing is an effective method of increasing heart rate and has been used in the assessment of coronary artery disease.

Methods

Both tests were performed in sequence on the same patients in random order. Transesophageal atrial pacing stress echocardiography began at a heart rate of 10 beats/min above the baseline value and was increased by 20 beats/min every two min until 85% of the age-predicted maximum heart rate or another end point was reached. Dobutamine echocardiography was performed using three-min stages and a maximum dose of 40 µg/kg per min. Atropine (total dose 2 mg) was administered at the start of the 40 µg/kg per min stage if needed to augment heart rate or during pacing if Wenckebach heart block occurred.

Results

Transesophageal atrial pacing stress echocardiography was feasible in 100 of 104 patients (96%); the duration (8.6 ± 3.6 min) was significantly shorter than that of dobutamine stress echocardiography (15.1 ± 3.9 min) (p = 0.0001). With transesophageal atrial pacing stress echocardiography, the recovery period was shorter, symptoms and dysrhythmias were fewer, hypertension and hypotension were less common and target heart rate was more frequently achieved. No complications occurred with either test. Patient acceptance was satisfactory. Agreement between results of both tests was good for segmental wall motion scoring with a 16-segment model, scores 1 to 5 (kappa: rest, 0.79; peak, 0.57) and test interpretation (normal, ischemia, infarction or resting wall motion abnormality with ischemia) (kappa: 0.77).

Conclusions

Transesophageal atrial pacing stress echocardiography is a feasible, well-tolerated alternative to dobutamine stress echocardiography. It can be performed rapidly and shows good agreement with dobutamine stress echocardiography in the induction of myocardial ischemia.

This article has been cited by other articles:

				M. Enriquez-Sarano, V. T. Nkomo, and H. Michelena Principles and Practice of Echocardiography in Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 315 - 348. [Full Text]

				E De Caro, G P Ussia, M Marasini, and G Pongiglione Transoesophageal atrial pacing combined with transthoracic two dimensional echocardiography: experience in patients operated on with arterial switch operation for transposition of the great arteries Heart, January 1, 2003; 89(1): 91 - 95. [Abstract] [Full Text] [PDF]

				E. Tadamura, H. Iida, K. Matsumoto, M. Mamede, S. Kubo, H. Toyoda, T. Shiozaki, T. Mukai, Y. Magata, and J. Konishi Comparison of myocardial blood flow during dobutamine-atropine infusion with that after dipyridamole administration in normal men J. Am. Coll. Cardiol., January 1, 2001; 37(1): 130 - 136. [Abstract] [Full Text] [PDF]

				S. Atar, T. Nagai, B. Cercek, T. Z. Naqvi, H. Luo, and R. J. Siegel Pacing stress echocardiography: an alternative to pharmacologic stress testing J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1935 - 1941. [Abstract] [Full Text] [PDF]

				A. J. Rainbird, P. A. Pellikka, V. L. Stussy, D. M. Mahoney, and J. B. Seward A rapid stress-testing protocol for the detection of coronary artery disease: Comparison of two-stage transesophageal atrial pacing stress echocardiography with dobutamine stress echocardiography J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1659 - 1663. [Abstract] [Full Text] [PDF]