Feasibility of Biventricular Pacing in Patients With Recent Myocardial Infarction: Impact on Ventricular Remodeling

To test the hypothesis that biventricular pacing after a myocardial infarction with reduced ejection fraction can attenuate left ventricular (LV) remodeling, the authors studied 18 patients (myocardial infarction within 30–45 days, ejection fraction ≤30%, narrow QRS) randomized to biventricular therapy (biventricular therapy + defibrillator) (biventricular group) or implantable cardioverter‐defibrillator alone (control group). At 1, 6, and 12 months, there were no differences in functional or clinical parameters (New York Heart Association, quality of life, 6‐minute walk). Twelve‐month LV volume remained stable in the biventricular group, but increased in the control group (median LV end‐diastolic volume increase, 6.5 mL in biventricular vs 35 mL in control; P=.03; median LV end‐diastolic volume decrease, 5.5 mL in biventricular vs 30.5‐mL increase in control; P=.11). Biventricular therapy also prevented an increase in sphericity index at 12 months (median, −2% in biventricular vs 37% in control; P=.06). Delivery of biventricular therapy early after myocardial infarction appears safe and feasible and may attenuate subsequent LV dilation.