Feasibility and safety of noninvasive pacemaker stress echocardiography with externally triggered stimulation

The aim of this study was to assess the feasibility and safety of stress echocardiography by triggering an implanted pacemaker through an external stimulator. The implanted pacemaker was set in triggered mode with unipolar sensitivity of <2 mV. The external stimulator, connected to 2 skin electrodes, tracked the implanted pacemaker at increasing rates. Fifteen patients (mean age 65 ± 8 years) with suspected coronary artery disease entered the study, and complete tests were performed in all patients. No adverse effects were reported. The method of externally triggered stimulation is feasible, safe, and allows a diagnosis in every patient with a pacemaker without additional cost.