In order to diagnose myocardial ischaemia, the authors performed transoesophageal atrial pacing using commercially available electrodes and a pacing device of their own design. On assessing the 12-lead electrocardiogram, they compared the results of pacing and exercise testing in 204 subjects. They found full agreement in all controls and in most IHD patients. In 33 persons, atrial pacing was combined with assessment of the ST segment precordial mapping. On atrial pacing mapping, the authors found manifestations of ischaemia similar to those discovered during exercise testing. Both methods have proved useful in the detection of myocardial ischaemia and are recommended as alternative techniques to exercise testing, especially in cases when the latter technique is not feasible or cannot be interpreted.