title: Peri-infarct zone pacing to prevent adverse left ventricular remodelling in patients with large myocardial infarction.
abstract: OBJECTIVE
  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).
  
  
  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.
  
  
  BACKGROUND
  NCT01213251.
authors: Columbia 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.
authors: Gregg W
authors: GW
authors: Stone
authors: The Christ Hospital, Cincinnati, OH, USA.
authors: Eugene S
authors: ES
authors: Chung
authors: Eastern Slovakia Institute for Cardiac and Vascular Diseases, Kosice, Slovakia.
authors: Branislav
authors: B
authors: Stancak
authors: Rigshospitalet and the University of Copenhagen, Copenhagen, Denmark.
authors: Jesper H
authors: JH
authors: Svendsen
authors: Medtronic, Plc., Minneapolis, MN, USA.
authors: Trent M
authors: TM
authors: Fischer
authors: Medtronic, Plc., Minneapolis, MN, USA.
authors: Fred
authors: F
authors: Kueffer
authors: The Ohio State University, Columbus, OH, USA.
authors: Thomas
authors: T
authors: Ryan
authors: Leiden University Medical Center, Leiden, The Netherlands.
authors: Jeroen
authors: J
authors: Bax
authors: Emory University School of Medicine, Atlanta, GA, USA.
authors: Angel
authors: A
authors: Leon
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: Heart failure; Left ventricular remodelling; Myocardial infarction; Prognosis