Right atrial pacing for risk stratification in patients with angina pectoris.

Right atrial pacing (RAP) has been used to assess the physiologic impact of coronary artery disease (CAD). Several variables have served as markers of pacing-induced myocardial ischemia or for predicting disease severity, but their clinical implications remain uncertain. Therefore, three-stage RAP was performed to evaluate whether this strategy could predict the disease severity of CAD and foretell subsequent major cardiac events in 49 patients with typical chest pain. RAP was considered positive if 1 mm or more of horizontal or downward ST depression developed. Of the 49 cases, 28 had positive RAP (group A), and the remaining 21 had negative RAP (group B). For hemodynamic data, early positive RAP had the highest post-pacing left ventricular end-diastolic pressure (LVEDP). The LVEDP increased significantly in Group A (p < 0.05), whereas there was no apparent change in group B. Furthermore, group A (36%) tended to develop typical chest pain more easily than group B (14%), but this was statistically insignificant. Group A had a higher incidence of multivessel disease than that of group B (p < 0.001), whereas group A had a lower incidence of non-significant CAD than that of group B (p < 0.001). During the mean two-year follow-up period, there were 23 major cardiac events (MCE) in group A in contrast to two episodes in group B (p < 0.005). The early positive subset had 18 episodes, whereas the late positive subset had only five episodes (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)