Atrial Pacing During Percutaneous Transluminal Coronary Angioplasty: Results and Comparison with Exercise Treadmill Testing

Stratmann, Henry; Aker, Umit T.; Vandormael, Michael G.; Ischinger, Thomas; Wiens, Robert; Kennedy, Harold L.
September 1987
Angiology;Sep1987, Vol. 38 Issue 9, p663
Academic Journal
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.


Related Articles

  • Intracoronary brachytherapy for in-stent restenosis: will it remain a viable therapy? Seong-Wook Park; Myeong-Ki Hong; Seung Jun Oh; Dae Hyuk Moon // European Journal of Nuclear Medicine & Molecular Imaging;2004, Vol. 31 Issue 9, p1219 

    Stent placement has replaced balloon angioplasty as the most commonly performed percutaneous coronary intervention procedure because of its acute and long-term advantages over balloon angioplasty. However, widespreaduse of stents has also led to a new problem, the in-stentrestenosis (ISR). ISR...

  • Perkutana intervencija karotidne stenoze uzrokovane radioterapijom Hodgkinovog limfoma. Sagić, D.; Kecmanović, V.; Vidaković, R.; Kovačević, V.; Antonić, Ž.; Stanišić, M.; Ilijevski, N.; Radak, Đ. // Acta Chirurgica Iugoslavica;2009, Vol. 56 Issue 4, p47 

    Frequent delayed effect of radiation therapy in the region of neck is stenosis of carotid arteries. We report the case of 32 years old man with history of radiation therapy due to Hodgkin lymphoma, and severe stenosis of the right common carotid artery. Stenosis was successfully treated by...

  • New route to angioplasty.  // Better Homes & Gardens;Jun95, Vol. 73 Issue 6, p62 

    Reports on Dallas, Tex.-based Baylor University Medical Center's use of the wrist as a new route during balloon coronary angioplasty. Technique used by doctors; Advantages of using the wrist as route compared with using the groin.

  • ST-T Alternans and Myocardial Ischemia. Kwan, Tak; Feit, Alan; Alam, Mahmood; Afflu, Ernest; Clark, Luther T. // Angiology;Mar1999, Vol. 50 Issue 3, p217 

    Previous studies using intracoronary electrocardiography have demonstrated that ST-T alternans can develop during standard balloon coronary angioplasty. Total occlusion with a large amount of myocardium in jeopardy is the postulated prerequisite. In this study, the authors used perfusion...

  • Is transfer for primary angioplasty better than on-site fibrinolytic therapy for acute myocardial infarction? Choi, Stephen // CMAJ: Canadian Medical Association Journal;9/30/2003, Vol. 169 Issue 7, p695 

    Provides information on a study that examined whether transfer to a centre with available percutaneous transluminal coronary angioplasty better than on-site fibrinolysis in the treatment of patients with acute ST-segment elevation myocardial infarction. Design of the study; Results of the...

  • Electrical and Mechanical Alternans During Percutaneous Transluminal Coronary Angioplasty in a Patient with Acute Myocardial Infarction. Konno, Tetsuo; Araki, Tsutomu; Soma, Ryuichirou; Takimoto, Hiroaki; Tofuku, Yohei; Shimizu, Masami // Angiology;Sep/Oct2004, Vol. 55 Issue 5, p569 

    The authors report a rare type of cardiac alternans during percutaneous transluminal coronary angioplasty (PTCA) in a patient with acute myocardial infarction. Not only ST segment but also QRS alternans were observed on electrocardiogram and were accompanied by mechanical alternans. The...

  • Successful Direct PTCA on LAD after First Episode of Acute Myocardial Infarction: Does It Improve Cardiac Function? Asonuma, Hirohiko; Tanji, Yasuhiro; Nakatoh, Hiroshi; Nakajima, Takanobu; Akita, Hirotoshi; Sasaki, Akira; Shoji, Kohjiro // Angiology;Sep1990 Part 1, Vol. 41 Issue 9, p724 

    Patients who received direct percutaneous transluminal coronary angioplasty (PTCA) after acute mycardial infarction and maintained potency but with unimproved cardiac function were studied. In 15 patients, the first episode of acute myocardial infarction was caused by a left anterior descending...

  • Timing of Catheterization in ACS. Boyle, Andrew J. // Clinical Cardiology Alert;May2010, Vol. 29 Issue 5, p33 

    The article discusses a study by P. Sorajja and colleagues on the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial data to determine the effect of delay to angioplasty in patients with non-ST elevation (NSTE) acute coronary syndromes (ACS), or NSTE-ACS, undergoing...

  • Balloon Angioplasty in Acute and Chronic Coronary Artery Disease. Holmes Jr., David R.; Vlietstra, Ronald E. // JAMA: Journal of the American Medical Association;4/14/89, Vol. 261 Issue 14, p2109 

    Discusses the use of balloon angioplasty in the treatment of acute and chronic coronary artery disease. Dependence of outcome of specific patient and angiographic characteristics; Success rates in ideal lesions; Unresolved issues.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics