title: Clinical pacing post-conditioning during revascularization after AMI.
abstract: Intermittent dyssynchrony, induced by ventricular pacing, during early reperfusion reduces infarct size in pre-clinical studies. We evaluated cardioprotection by pacing post-conditioning (PPC) in ST-segment elevation myocardial infarction in a randomized, controlled, single-center, single-blinded, first-in-man study. Patients with first ST-segment elevation myocardial infarction received either PPC plus percutaneous coronary intervention (PCI) (n = 30) or PCI (n = 30). PPC consisted of 10 episodes of 30-s right ventricular pacing. Infarct size was measured as the area under the curve of creatine kinase (CK) (primary endpoint) and by contrast-enhanced cardiac magnetic resonance. The CK area under the curve was not significantly different between study groups. Adjusted contrast-enhanced cardiac magnetic resonance data showed ∼25% smaller infarct size in PPC + PCI than in PCI patients after 4 days (p = 0.01), 4 months (p = 0.02), and 1 year of PCI (p = 0.08). In PPC + PCI, (uncomplicated) ventricular fibrillation (n = 3) and paroxysmal atrial fibrillation (n = 4) were observed as opposed to 1 and 0 cases in PCI, respectively. We conclude PPC is feasible and may induce cardioprotection during PCI treatment of ST-segment elevation myocardial infarction, but technical improvements are needed to improve safety. (PROTECT: Pacing to Protect Heart for Damage From Blocked Heart Vessel and From Re-opening Blocked Vessel[s]; NCT00409604).
authors.affiliation: Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany. Electronic address: Waltenberger@ukmuenster.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Waltenberger
authors.affiliation: Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Marloes
authors.initials: M
authors.lastname: Gelissen
authors.affiliation: Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Sebastiaan C
authors.initials: SC
authors.lastname: Bekkers
authors.affiliation: Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Jindra
authors.initials: J
authors.lastname: Vainer
authors.affiliation: Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Vincent
authors.initials: V
authors.lastname: van Ommen
authors.affiliation: Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Filip
authors.initials: F
authors.lastname: Eerens
authors.affiliation: Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ruiters
authors.affiliation: Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Alexa
authors.initials: A
authors.lastname: Holthuijsen
authors.affiliation: Boston Scientific, Diegem, Belgium.
authors.forename: Paqui
authors.initials: P
authors.lastname: Cuesta
authors.affiliation: Boston Scientific, Diegem, Belgium.
authors.forename: Racho
authors.initials: R
authors.lastname: Strauven
authors.affiliation: Boston Scientific, St. Paul, Minnesota.
authors.forename: Eric
authors.initials: E
authors.lastname: Mokelke
authors.affiliation: Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Anton
authors.initials: A
authors.lastname: Gorgels
authors.affiliation: Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Frits W
authors.initials: FW
authors.lastname: Prinzen
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000517:prevention & control; D002304:Cardiac Pacing, Artificial; D005260:Female; D006801:Humans; D056989:Inferior Wall Myocardial Infarction / Q000628:therapy; D057775:Ischemic Postconditioning / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D009204:Myocardial Revascularization; D062645:Percutaneous Coronary Intervention; D016037:Single-Blind Method
keywords: acute myocardial infarction; arrhythmias; cardioprotection; pacing post-conditioning; primary PCI; reperfusion injury