R-wave amplitude responses to rapid atrial pacing: a marker for myocardial ischemia

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 less than 0.01); and in nonischemic patients: phase I: -11% (p less than 0.02), phase II: -18% (p less than 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.(ABSTRACT TRUNCATED AT 250 WORDS)