Rapid atrial pacing for detecting provokable demand ischemia in anesthetized patients

Anesthesia and Analgesia
M D SeebergerN B Schiller

Abstract

A stress test that can be performed intraoperatively might be valuable for cardiac risk stratification in patients needing urgent noncardiac surgery and for early evaluation of coronary reserve in patients undergoing aortocoronary bypass surgery. Therefore, we evaluated the sensitivity and safety of rapid atrial pacing combined with electrocardiography and transesophageal echocardiography for inducing and detecting provokable demand ischemia in 20 anesthetized patients with multivessel coronary artery disease. Rapid atrial pacing induced ST segment changes or new segmental wall motion abnormalities (SWMA), which were defined as evidence of induced ischemia in 15 of the 20 patients. Unexpectedly, the new SWMA normalized during the first beat after abrupt cessation of pacing in three patients who did not show any ST segment changes. Simultaneously, left ventricular preload was severely decreased during pacing and recovered to baseline immediately when pacing was abruptly discontinued. Rapid atrial pacing was safe in all patients, but the target heart rate could not be achieved because of heart block or arterial hypotension in 4 of the 20 patients. These findings raise the question of whether rapid atrial pacing is the most approp...Continue Reading

References

Jun 1, 1988·Annals of Internal Medicine·T H Lee, L Goldman
Aug 23, 1985·The American Journal of Cardiology·D C Harrison
Feb 1, 1986·Anesthesiology·J TarnowU Schulte-Sasse
Apr 1, 1994·Anesthesia and Analgesia·M D SeebergerJ Hruby

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