TY - JOUR
T1 - R-wave amplitude responses to rapid atrial pacing
T2 - A marker for myocardial ischemia
AU - David, Daniel
AU - Kitchen, James G.
AU - Michelson, Eric L.
AU - Naito, Masahito
AU - Sawin, Henry S.
AU - Chen, Chin C.
N1 - Funding Information:
Supported in part by a Fellowship Award from the American Association, Southeastern Pennsylvania Chapter, Philadelphia, David), and a Clinical Investigatorship Award 5 KO8 HLOO’709-02 National Heart, Lung, and Blood Institute, National Institutes Bethesda, Md. (Dr. Michelson). for publication May 14, 1982; accepted requests: Eric L. Michelson, M.D., The Lankenau Center, Lancaster and City Line Ave., Philadelphia,
PY - 1984/1
Y1 - 1984/1
N2 - Atrial pacing-induced changes in the sum of R-wave amplitude were measured in leads V5, X, Y, and Z at rates of 100 bpm (phase I), 150 bpm (phase II), and immediately after pacing (phase III) in 33 patients undergoing cardiac catheterization for evaluation of chest pain. Seventeen (51%) patients showed evidence of ischemia during atrial pacing (typical anginal pain and/or at least a 1 mm ST-segment depression) and 16 (49%) showed no evidence of ischemia. Mean R-wave amplitude changes from baseline in the ischemic patients were: phase I; -8% (p = not significant), phase II: +3% (p = not significant), and phase III: +13% (p < 0.01); and in nonischemic patients: phase I: -11% (p < 0.02), phase II: -18% (p < 0.01), and phase III: +2% (p = not significant). These two distinct patterns of R-wave amplitude changes were highly sensitive (85%), specific (92%), and predictive (92%) for identifying patients with myocardial ischemia but did not correlate (p = not significant) with either the angiographically determined extent of coronary artery obstructive disease (CAD), resting left ventricular function, or the dynamic, atrial pacing-induced changes in left ventricular dimensions determined by M-mode and two-dimensional echocardiography. Thus, R-wave amplitude changes induced by atrial pacing can be used to identify patients with myocardial ischemia independent of coronary anatomy or resting left ventricular function. In addition, it appears that R-wave amplitude variations during atrial pacing-induced myocardial ischemia are not directly related to left ventricular volume changes.
AB - Atrial pacing-induced changes in the sum of R-wave amplitude were measured in leads V5, X, Y, and Z at rates of 100 bpm (phase I), 150 bpm (phase II), and immediately after pacing (phase III) in 33 patients undergoing cardiac catheterization for evaluation of chest pain. Seventeen (51%) patients showed evidence of ischemia during atrial pacing (typical anginal pain and/or at least a 1 mm ST-segment depression) and 16 (49%) showed no evidence of ischemia. Mean R-wave amplitude changes from baseline in the ischemic patients were: phase I; -8% (p = not significant), phase II: +3% (p = not significant), and phase III: +13% (p < 0.01); and in nonischemic patients: phase I: -11% (p < 0.02), phase II: -18% (p < 0.01), and phase III: +2% (p = not significant). These two distinct patterns of R-wave amplitude changes were highly sensitive (85%), specific (92%), and predictive (92%) for identifying patients with myocardial ischemia but did not correlate (p = not significant) with either the angiographically determined extent of coronary artery obstructive disease (CAD), resting left ventricular function, or the dynamic, atrial pacing-induced changes in left ventricular dimensions determined by M-mode and two-dimensional echocardiography. Thus, R-wave amplitude changes induced by atrial pacing can be used to identify patients with myocardial ischemia independent of coronary anatomy or resting left ventricular function. In addition, it appears that R-wave amplitude variations during atrial pacing-induced myocardial ischemia are not directly related to left ventricular volume changes.
UR - http://www.scopus.com/inward/record.url?scp=0021334721&partnerID=8YFLogxK
U2 - 10.1016/0002-8703(84)90133-9
DO - 10.1016/0002-8703(84)90133-9
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
AN - SCOPUS:0021334721
SN - 0002-8703
VL - 107
SP - 53
EP - 61
JO - American Heart Journal
JF - American Heart Journal
IS - 1
ER -
