Symptomatic, electrocardiographic, metabolic, and hemodynamic alterations during pacing-induced myocardial ischemia

Details

Serval ID
serval:BIB_7867365E70A2
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Symptomatic, electrocardiographic, metabolic, and hemodynamic alterations during pacing-induced myocardial ischemia
Journal
American Journal of Cardiology
Author(s)
Markham, R. V., Jr. , Winniford  M. D., Firth  B. G., Nicod  P., Dehmer  G. J., Lewis  S. E., Hillis  L. D.
ISSN
0002-9149 (Print)
Publication state
Published
Issued date
06/1983
Volume
51
Number
10
Pages
1589-94
Notes
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S. --- Old month value: Jun
Abstract
Atrial pacing has been used to assess the physiologic impact of coronary artery disease (CAD). Several variables have served as markers of pacing-induced myocardial ischemia, but their specificities and sensitivities are unknown. Accordingly, in 28 patients, incremental atrial pacing was performed. Of the 28, 10 had no CAD. The left ventricular ejection fraction (LVEF) (by gated equilibrium blood pool scintigraphy) increased in this group (0.60 +/- 0.11 [mean +/- standard deviation] before pacing to 0.67 +/- 0.13 at peak-pacing, p = 0.002). In no patient did left ventricular end-diastolic pressure increase by greater than 5 mm Hg. No patient had lactate production, and 2 (20%) had electrocardiographic S-T segment depression greater than or equal to 0.1 mV. Four (40%) had chest pain with atrial pacing. In the remaining 18 patients with CAD, atrial pacing caused a decrease in LVEF greater than or equal to 0.05 (0.46 +/- 0.10 to 0.33 +/- 0.09, p less than 0.001) and new segmental wall motion abnormalities in all, indicating pacing-induced myocardial ischemia. Only 8 (44%) had an increase in left ventricular end-diastolic pressure of greater than 5 mm Hg, and only 9 (50%) had lactate production. Ten (56%) had ischemic electrocardiographic changes, and 12 (67%) had chest pain. Thus, the electrocardiographic, metabolic, and hemodynamic alterations that may accompany pacing-induced ischemia are specific but relatively insensitive markers of ischemia. In contrast, chest pain during atrial pacing is a nonspecific occurrence, appearing with similar frequency in normal subjects and patients with CAD and pacing-induced ischemia.
Keywords
Adult Aged Blood Pressure *Cardiac Pacing, Artificial/adverse effects Coronary Disease/etiology/*physiopathology Electrocardiography Female Heart Rate Heart Ventricles/radionuclide imaging Humans Lactates/blood Male Middle Aged Oxygen/blood Stroke Volume
Pubmed
Web of science
Create date
25/01/2008 13:59
Last modification date
20/08/2019 14:35
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