Clinical Pacing Post-Conditioning During Revascularization After AMI

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• 作者：Johannes Waltenberger ; MD^&lowast ; ; ^&dagger ; ; ^{Waltenberger@ukmuenster.de" class="auth_mail} ; Marloes Gelissen ; BS^&lowast ; ; ^&Dagger ; ; Sebastiaan C. Bekkers ; MD ; PhD^&lowast ; ; Jindra Vainer ; MD^&lowast ; ; Vincent van Ommen ; MD ; PhD^&lowast ; ; Filip Eerens ; MD^&lowast ; ; Alexander Ruiters ; MD^&lowast ; ; Alexa Holthuijsen ; RN^&lowast ; ; Paqui Cuesta ; PhD^§ ; ; Racho Strauven ; MS ; MS^§ ; ; Eric Mokelke ; MS^鈥?/sup> ; Anton Gorgels ; MD ; PhD^&lowast ; ; Frits W. Prinzen ; MD ; PhD^&Dagger ;
• 关键词：acute myocardial infarction ; arrhythmias ; cardioprotection ; pacing post-conditioning ; primary PCI ; reperfusion injury
• 刊名：JACC: Cardiovascular Imaging
• 出版年：June 2014
• 年：2014
• 卷：7
• 期：6
• 页码：620-626
• 全文大小：576 K

文摘

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)