Atrial pacing has been recently re-evaluated as a stress test for the detection of coronary artery disease. This sort of stress, especially if used in conjunction with cardiac imaging techniques can be considered a reliable alternative to physical exercise. In patients with recent myocardial infarction it can be usefully and safely utilized to obtain prognostic information. In fact, patients with recent myocardial infarction and a positive electrocardiogram (decreases ST greater than or equal to 1 mm) during atrial pacing more frequently than others present subsequent major cardiac events. Limitations of traditional pacing test (invasivity, poor sensitivity of electrocardiography) can be overcome with a new test we have recently proposed: two-dimensional echocardiography during atrial pacing. We have used this new stress test to detect patients with significant coronary artery disease, to identify patients with myocardial infarction and multivessel disease and to evaluate the effect of coronary artery bypass surgery.