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 similar to 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)
| Original language | English |
|---|---|
| Pages (from-to) | 620-626 |
| Journal | JACC-Cardiovascular Imaging |
| Volume | 7 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Jun 2014 |
Keywords
- acute myocardial infarction
- arrhythmias
- cardioprotection
- pacing post-conditioning
- primary PCI
- reperfusion injury
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Waltenberger, J., Gelissen, M., Bekkers, S. C., Vainer, J., van Ommen, V., Eerens, F., Ruiters, A., Holthuijsen, A., Cuesta, P., Strauven, R., Mokelke, E., Gorgels, A. (2014). Clinical Pacing Post-Conditioning During Revascularization After AMI. JACC-Cardiovascular Imaging, 7(6), 620-626. https://doi.org/10.1016/j.jcmg.2014.01.017
Waltenberger, Johannes ; Gelissen, Marloes ; Bekkers, Sebastiaan C. et al. / Clinical Pacing Post-Conditioning During Revascularization After AMI. In: JACC-Cardiovascular Imaging. 2014 ; Vol. 7, No. 6. pp. 620-626.
@article{7afe1da8cbda455ebe92b89e8cf65dfd,
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 similar to 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) ",
keywords = "acute myocardial infarction, arrhythmias, cardioprotection, pacing post-conditioning, primary PCI, reperfusion injury",
author = "Johannes Waltenberger and Marloes Gelissen and Bekkers, {Sebastiaan C.} and Jindra Vainer and {van Ommen}, Vincent and Filip Eerens and Alexander Ruiters and Alexa Holthuijsen and Paqui Cuesta and Racho Strauven and Eric Mokelke and Anton Gorgels and Prinzen, {Frits W.}",
year = "2014",
month = jun,
doi = "10.1016/j.jcmg.2014.01.017",
language = "English",
volume = "7",
pages = "620--626",
journal = "JACC-Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier Science",
number = "6",
}
Waltenberger, J, Gelissen, M, Bekkers, SC, Vainer, J, van Ommen, V, Eerens, F, Ruiters, A, Holthuijsen, A, Cuesta, P, Strauven, R, Mokelke, E, Gorgels, A 2014, 'Clinical Pacing Post-Conditioning During Revascularization After AMI', JACC-Cardiovascular Imaging, vol. 7, no. 6, pp. 620-626. https://doi.org/10.1016/j.jcmg.2014.01.017
Clinical Pacing Post-Conditioning During Revascularization After AMI. / Waltenberger, Johannes; Gelissen, Marloes; Bekkers, Sebastiaan C. et al.
In: JACC-Cardiovascular Imaging, Vol. 7, No. 6, 06.2014, p. 620-626.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Clinical Pacing Post-Conditioning During Revascularization After AMI
AU - Waltenberger, Johannes
AU - Gelissen, Marloes
AU - Bekkers, Sebastiaan C.
AU - Vainer, Jindra
AU - van Ommen, Vincent
AU - Eerens, Filip
AU - Ruiters, Alexander
AU - Holthuijsen, Alexa
AU - Cuesta, Paqui
AU - Strauven, Racho
AU - Mokelke, Eric
AU - Gorgels, Anton
AU - Prinzen, Frits W.
PY - 2014/6
Y1 - 2014/6
N2 - 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 similar to 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)
AB - 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 similar to 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)
KW - acute myocardial infarction
KW - arrhythmias
KW - cardioprotection
KW - pacing post-conditioning
KW - primary PCI
KW - reperfusion injury
U2 - 10.1016/j.jcmg.2014.01.017
DO - 10.1016/j.jcmg.2014.01.017
M3 - Article
C2 - 24925330
SN - 1936-878X
VL - 7
SP - 620
EP - 626
JO - JACC-Cardiovascular Imaging
JF - JACC-Cardiovascular Imaging
IS - 6
ER -
Waltenberger J, Gelissen M, Bekkers SC, Vainer J, van Ommen V, Eerens F et al. Clinical Pacing Post-Conditioning During Revascularization After AMI. JACC-Cardiovascular Imaging. 2014 Jun;7(6):620-626. doi: 10.1016/j.jcmg.2014.01.017
