Peri-infarct zone pacing to prevent adverse left ventricular remodelling in patients with large myocardial infarction

Gregg W. Stone, Eugene S. Chung, Branislav Stancak, Jesper H. Svendsen, Trent M. Fischer, Fred Kueffer, Thomas Ryan, Jeroen Bax, Angel Leon

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Aims We sought to determine whether peri-infarct pacing prevents left ventricular (LV) remodelling and improves functional and clinical outcomes in patients with large first myocardial infarction (MI). Methods and results A total of 126 patients at 27 international sites within 10 days of onset of anterior or non-anterior MI with creatine phosphokinase >3000 U/L and QRS duration ≤120 ms were randomized 1:1:1 to dual-site biventricular pacing vs. single-site LV only pacing vs. non-implanted control. The primary endpoint was the echocardiographic core laboratory-assessed change in LV end-diastolic volume (ΔLVEDV) from baseline to 18 months between the pooled pacing therapy groups and the control group. ΔLVEDV increased by 15.3 ± 28.6 mL in the control group and by 16.7 ± 30.5 mL in the pooled pacing groups during follow-up (adjusted mean difference (95% CI) = 0.6 (-12.3, 13.5) mL, P = 0.92). There were also no significant between-group differences in the change in LV end-systolic volume or ejection fraction over time. Quality of life, as assessed by the Minnesota Living with Heart Failure (HF) and European Quality of Life-5 Dimension questionnaires and New York Heart Association class, was also similar between groups during 18-month follow-up. Six-minute walk distance improved during follow-up to an equal degree between groups, and there were no significant differences in the 18-month rates of death or HF hospitalization between the pooled pacing therapy vs. control groups (17.4 vs. 21.7% respectively, P = 0.59). Conclusions In the present multicentre, randomized trial, peri-infarct pacing did not prevent LV remodelling or improve functional or clinical outcomes during 18-month follow-up in patients with large first MI. ClinicalTrials.gov identifier NCT01213251.

Original languageEnglish
Pages (from-to)484-493
Number of pages10
JournalEuropean Heart Journal
Volume37
Issue number5
DOIs
StatePublished - 1 Feb 2016
Externally publishedYes

Keywords

  • Heart failure
  • Left ventricular remodelling
  • Myocardial infarction
  • Prognosis

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