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If you are a patient currently in atrial fibrillation. Generally speaking an adenosine or lexiscan nuclear stress tests are usually the best options. The other medicated stress test is Dobutamine (both echocardiogram and Nuclear). You do not want to use Dobutamine on patients at risk to go into atrial fibrillation because it is a drug that can induce it. For patients that are in chronic atrial fibrillation dobutamine can be used but is not considered to be as diagnostic as a lexiscan or adenosine stress test. The reason being (and this goes or exercise stress tests as well) dobutamine is a heart rate dependent test. This means the closer the heart rate gets to the patients age predicted max HR the more accurate the test is at detecting Heart disease. The assumption in this is that the patient is in a sinus rhythm. Myocardial oxygen demand correlates directly with patients HR when the patient is in sinus rhythm. If the patient is in atrial fibrillation that correlation with myocardial oxygen demand becomes much more cloudy thus reducing the sensitivity of an exercise or dobutamine stress test with patients in atrial fibrillation. Both lexiscan and adenosine eliminate HR demands in detecting CAD which makes them the best test for a.fib patients.

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