We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Atrial Pacing During Percutaneous Transluminal Coronary Angioplasty: Results and Comparison with Exercise Treadmill Testing.
- Authors
Stratmann, Henry; Aker, Umit T.; Vandormael, Michael G.; Ischinger, Thomas; Wiens, Robert; Kennedy, Harold L.
- Abstract
Right atrial pacing (RAP) was used to immediately assess improvement in threshold for myocardial ischemia in 23 patients undergoing angiographically successful percutaneous transluminal coronary angioplasty (PTCA). Multiple coronary lesions were present in 19 patients, and 15 had incomplete revascularization. All patients had RAP done immediately before and after completion of all dilatations, and in 13 patients pre- and post-PTCA exercise treadmill tests (ETT) were also performed. Angina occurred in 16 (70%) patients during pre- PTCA RAP, hut in only 4 (17%) after PTCA (p<.05). The electrocardiogram was positive for ischemia (horizontal or downsloping ST depression > 1 mm) in 18 patients (78%) during pre-PTCA RAP. However, 13 patients (57%) continued to have an ischemic response during post-PTCA RAP (not significant—NS). In 4 patients with multiple coronary lesions who had sequential pacing studies after PTCA of each lesion, the maximum degree of ST depression decreased by 1 mm or more after each dilatation in 3 patients hut remained > 1 mm in all. In the 13 patients undergoing both RAP and ETT, angina developed in 7 during pre-PTCA RAP and in 2 after PTCA (p < .05), compared with 8 and 3 (p < .05) during pre- and post-PTCA ETT, respectively. Ischemic ST depression occurred in 9 patients during pre-PTCA RAP and in 6 after PTCA (NS), and in 8 and 6 (NS) during pre- and post-PTCA ETT, respectively. Concordance between the two tests was good. The authors conclude that RAP can be used to document improvements in the threshold for ischemia as assessed by angina and, less consistently, by ST depression. However, use of RAP to guide PTCA of individual lesions is limited in patients with multiple coronary lesions (especially those undergoing incomplete revascularization), owing to difficulty in determining which lesion(s) are responsible for persistent ischemic ST depression (present in most patients with positive pre-PTCA tests) after PTCA. RAP does compare favorably with ETT for assessing post-PTCA ischemia and can be used as a substitute for exercise testing in patients unable to perform an adequate ETT.
- Subjects
TRANSLUMINAL angioplasty; ARTERIAL catheterization; DIAGNOSTIC use of transluminal angioplasty; CORONARY disease; HEART diseases; HEART physiology
- Publication
Angiology, 1987, Vol 38, Issue 9, p663
- ISSN
0003-3197
- Publication type
Article
- DOI
10.1177/000331978703800903