Background : Noninvasive diagnosis of coronary artery disease in patients with permanent pacemakers is difficult. That is because of uninterpretable electrocardiogram and low specificity of perfusion scintigraphy in pacemaker patients. We evaluated diagnostic accuracy of noninvasive pacemaker stress echocardiography (PASE) as a screen test for coronary artery disease in asymptomatic patients with permanent pacemaker. Methods : Transthoracic stress-pacing echocardiography was performed in 14 patients with a dominant permanent pacemaker rhythm (8 men, 6 women; age, 71.4 짹 11.6 years). All patients underwent noninvasive pacemaker-stress test by external programming upto 120 beats per minute and compared with wall motion abnormalities at rest. Coronary angiography was performed in 7 patients with positive test result. Siginificant Coronary artery disease was defined as 쨀 70% stenosis in at least one major coronary artery. Results : Echocardiographic images were interpretable in all patients. No significant side effects were observed. Left ventricular systolic function was preserved in all patients (LV EF, 64.8 짹 6.7 %). Only 4 (57.1%) of 7 patients showed the significant coronary artery disease documented by coronary angiography. Conclusion : Noninvasive PASE is a simple, rapid, safe, and diagnostical efficient tool as a screen test for coronary artery disease in asymptomatic patients with permanent pacemaker. Larger studies are necessary to validate our finding.