Document Detail


Effect of peri-infarct pacing early after myocardial infarction: results of the prevention of myocardial enlargement and dilatation post myocardial infarction study.
MedLine Citation:
PMID:  20852059     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Left ventricular (LV) remodeling has been attributed to the segmental loss of viable myocardium due to myocardial infarction (MI), which results in redistribution of cardiac workload, with increased regional wall stress in and around the infarct zone. Because ventricular pacing has been shown to reduce regional wall stress and workload in regions near the pacing site, this trial was designed to test whether chronic pacing near the infarct attenuates LV remodeling.
METHODS AND RESULTS: Eighty patients with an anterior MI, peak creatine kinase >2000 mU/mL, ejection fraction ≤35%, wall motion abnormality (WMA) in >5 of 16 segments, and QRS <120 ms, were randomized to either control (implantable cardioverter-defibrillator [ICD]) or biventricular pacing with peri-infarct LV lead placement (cardiac resynchronization therapy [CRT]-D) arms between 2 and 14 days after the MI. The primary end point-change in LV end-diastolic volume (LVEDV) from baseline to 12 months-was not significantly different between the 2 groups (CRT, 10.6±27.7 mL; ICD, 11.2±31.2 mL; 2-sample t test P>0.05). In a hypothesis-generating secondary analysis, there was a sustained reduction in the WMA score at 12 months in paced patients (CRT, -0.16±0.28; ICD, -0.01±0.24, 2-sample t test P=0.03). No differences were found in the therapy-related event rate, hospitalizations, or mortality (all P>0.05).
CONCLUSIONS: Chronic pacing in the infarct region did not alter the primary end point of LV remodeling over 1 year.
Authors:
Eugene S Chung; Dan Dan; Scott D Solomon; Alan J Bank; Joseph Pastore; Anand Iyer; Ronald D Berger; Jay O Franklin; Gregory Jones; Christian Machado; Craig M Stolen
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2010-09-17
Journal Detail:
Title:  Circulation. Heart failure     Volume:  3     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-18     Completed Date:  2010-12-17     Revised Date:  2011-10-27    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  650-8     Citation Subset:  IM    
Affiliation:
The Heart and Vascular Center, The Christ Hospital, 2123 Auburn Ave, Cincinnati, OH 45219, USA. chunge@ohioheart.org
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00605631
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anterior Wall Myocardial Infarction / complications*,  physiopathology,  therapy*
Cardiac Resynchronization Therapy*
Cardiomegaly / etiology,  prevention & control*
Defibrillators, Implantable
Dilatation, Pathologic / etiology,  prevention & control*
Feasibility Studies
Female
Humans
Male
Middle Aged
Single-Blind Method
Treatment Outcome
Ventricular Remodeling

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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