Peri-infarct zone pacing to prevent adverse left ventricular remodelling in patients with large myocardial infarction
Gregg W Stone1, Eugene S Chung2, Branislav Stancak3
1Columbia University Medical Center, New York-Presbyterian Hospital, and the Cardiovascular Research Foundation, 111 E. 59th St., 11th Floor, New York, NY 10022, USA gs2184@columbia.edu gstone@crf.org.
Insights
Peri-infarct pacing did not prevent left ventricular remodelling or improve outcomes in patients after a large myocardial infarction. This randomized trial found no significant differences in clinical or functional measures between pacing and control groups.
Area of Science:
- Cardiology
- Biomedical Engineering
- Clinical Trials
Background:
- Myocardial infarction (MI) can lead to left ventricular (LV) remodeling.
- Peri-infarct pacing is a potential strategy to mitigate adverse LV remodeling post-MI.
- Previous studies have yielded inconclusive results on the efficacy of pacing in this context.
Purpose of the Study:
- To investigate if peri-infarct pacing prevents LV remodeling after a large first myocardial infarction (MI).
- To assess the impact of peri-infarct pacing on functional and clinical outcomes in post-MI patients.
- To compare dual-site biventricular pacing, single-site LV pacing, and non-implanted control groups.
Main Methods:
- A multicenter, randomized controlled trial involving 126 patients with large first MI.
- Patients were randomized to dual-site biventricular pacing, single-site LV pacing, or a non-implanted control group.
- Primary endpoint was change in LV end-diastolic volume at 18 months; secondary endpoints included functional and clinical outcomes.
Main Results:
- Peri-infarct pacing did not significantly alter LV end-diastolic volume compared to the control group (adjusted mean difference: 0.6 mL; P=0.92).
- No significant differences were observed in LV end-systolic volume, ejection fraction, quality of life, or 6-minute walk distance between groups.
- Eighteen-month rates of death or heart failure hospitalization were similar between pooled pacing groups and the control group (17.4% vs. 21.7%).
Conclusions:
- Peri-infarct pacing failed to prevent left ventricular remodeling in patients with large first MI.
- The pacing strategy did not lead to significant improvements in functional capacity or clinical outcomes over 18 months.
- This trial suggests peri-infarct pacing is not effective for managing LV remodeling and improving outcomes post-MI.
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.
Clinicaltrialsgov Identifier:
NCT01213251.
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