USEFULNESS OF TRANSESOPHAGEAL ATRIAL-PACING COMBINED WITH 2-DIMENSIONAL ECHOCARDIOGRAPHY (ECHO-PACING) IN PREDICTING THE PRESENCE AND SITE OF RESIDUAL JEOPARDIZED MYOCARDIUM AFTER UNCOMPLICATED ACUTE MYOCARDIAL-INFARCTION

The usefulness of transesophageal atrial pacing combined with 2-dimens ional echocardiography (echo-pacing) in predicting the presence and si te of jeopardized myocardium, defined as areas of myocardium perfused by a vessel with a stenosis greater-than-or-equal-to 75% or by a colla teral circulation if the supplying vessel was occluded, was evaluated in 31 patients with uncomplicated acute myocardial infarction who unde rwent coronary angiography. All 5 patients without jeopardized myocard ium had a negative test, whereas 24 of 26 with jeopardized muscle had a positive test (sensitivity 92%; specificity 100%). To identify the s ite of jeopardized myocardium, tests that were positive for developmen t of new asynergies were analyzed further, distinguishing those positi ve in the infarct or remote zone. Seven of 8 patients with new asynerg ies in the remote zone had areas of jeopardized myocardium outside the territory of distribution of the infarct-related vessel, whereas only 2 of 12 with new asynergies in the infarct zone had areas of jeopardi zed myocardium outside that territory (p <0.01), correctly predicting the site of jeopardized myocardium in 17 of 20 cases. In conclusion, e cho-pacing is useful for detecting the presence and site of jeopardize d myocardium after an acute myocardial infarction.