Feasibility and safety of transeophageal atrial pacing stress echocardiography in patients with known or suspected coronary artery disease

To investigate the feasibility and safety of the transesophageal atrial pacing stress test combined with echocardiography (TAPSE) 1,727 TAPSE tests were performed on 1,641 patients consecutively referred to our echocardiographic laboratory for nonexercise stress testing (1,319 men; mean age 60 ± 9 years; 34% of whom were outpatients). Wall motion abnormalities were present at baseline echocardiography in 975 cases (56%). TAPSE was feasible in 1,648 cases (95.4%). It was not feasible in 79 patients due to failure of positioning the transnasal catheter (n = 11), the patientʹs intolerance of esophageal stimulation (n = 24), failure to obtain any or stable atrial capture (n = 36), or because the echocardiogram could not be evaluated at the peak of the test (n = 8). TAPSE was diagnostic in 1,584 cases (96% of the feasible tests, 92% of all attempts). TAPSE was nondiagnostic in 64 cases (4% of the feasible tests) due to second-degree atrioventricular type I block resistance to atropine administration with failure to achieve 85% of the age-predicted maximum heart rate (n = 59) or due to side effects, such as arrhythmias (n = 3) or hypertension (n = 2), which required premature interruption of the test. There were no major complications (death, myocardial infarction, or life-threatening arrhythmias). There were 28 instances of minor complications that comprised transient arrhythmias, including atrial fibrillation (n = 8), paroxysmal supraventricular tachycardia (n = 6), automatic atrial tachycardia (n = 1), sinus arrest (n = 1), atrioventricular junctional rhythm (n = 2), ectopic atrial rhythm (n = 2), nonsustained ventricular tachycardia (maximum 6 beats, n = 3), hypotension (n = 1), and hypertension (n = 4) leading to interruption of the test. Only 5 complications hampered a diagnostic result, whereas 18 occurred during or after a positive test and 5 during a negative, but diagnostic, test. Thus, TAPSE is a highly feasible and very safe stress test. It gives high percentage of diagnostic tests and may represent a valid alternative to pharmacologic stressors.