The Post-Myocardial Infarction Pacing Remodeling Prevention Therapy (PRomPT) Trial: Design and Rationale

Area of Science:

• Cardiology
• Biomedical Engineering

Background:

• Large myocardial infarctions (MI) pose a significant risk for heart failure development, despite medical advancements.
• Implantable cardioverter defibrillators reduce arrhythmic deaths post-MI but do not impact overall mortality.
• Novel interventions are crucial to decrease morbidity and mortality in large MI patients.

Purpose of the Study:

• To evaluate the efficacy of peri-infarct pacing in preventing adverse cardiac remodeling following myocardial infarction.
• To assess the impact of biventricular pacing on left ventricular remodeling and clinical outcomes in patients with large MI.

Main Methods:

• The Pacing Remodeling Prevention Therapy (PRomPT) trial randomizes up to 120 large MI patients to dual-site or single-site biventricular pacing or a control group.
• Left ventricular lead implantation in a peri-infarct region is performed within 10 days of MI.
• Primary endpoint: change in left ventricular end-diastolic volume at 18 months; secondary endpoints include heart failure hospitalizations, cardiovascular events, and mortality.

Main Results:

• This section is not available in the provided abstract.

Conclusions:

• The PRomPT trial aims to provide critical evidence on peri-infarct pacing's potential to mitigate adverse remodeling in large MI patients.
• Findings will inform future therapeutic strategies for improving outcomes in this high-risk population.