Arizona Arrhythmia Consultants and Leading Universities Investigate a New Technique to Prevent the Development of Heart Failure After a Heart Attack.

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Arizona Arrhythmia Consultants and leading Universities collaborate to study pacing therapy to prevent heart failure after a heart attack. Arizona Arrhythmia Consultants was ranked among the top 5 centers nationally to carry out the study.

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“Major advances in arrhythmia management have been made possible by scientific study and participation of patients. Arizona Arrhythmia Consultants has been able to offer state-of-the-art therapy options to our patients due to our research endeavors

People who have a heart attack are at high risk of death and hospitalization for heart failure. These events markedly affect quality of life and increase healthcare costs. Approximately 1.2 million people per year will have a heart attack, costing up to $165.4 billion despite recent improvements in detection and treatment of heart attacks. People who survive their heart attack are 1.5 to 15 times more likely to have related illnesses and death. Within 5 years of a heart attack the overall risk of developing heart failure is reported to range from 7% to 29% (1). The overall incidence of heart failure continues to increase.

Current medical treatment following a heart attack is focused on preventing progression of heart failure. Although there is an arrhythmic death risk in this population, device therapy for primary prevention of arrhythmia is not indicated until at least 40 days after the heart attack and with established heart failure and documented decrease in left ventricular ejection fraction. In addition, cardiac resynchronization therapy is not indicated until heart failure is diagnosed as chronic and associated with evidence of ventricular dysynchronization (2).

Cardiac resynchronization therapy or biventricular pacing, has evolved as a treatment for heart failure. Long term biventricular pacing results in improvement of heart function with concomitant symptomatic improvement. Biventricular pacing has resulted in improved contractile function, reduced mitral regurgitation, and reverse remodeling (3-5). In regards to remodeling, pacing in the peri-infarct zone was found to reduce local stroke work and possibly prevent adverse remodeling that occurs after a heart attack. The PROMPT study was designed to test this theory.

The PROMPT study investigated pacing after a heart attack in order to prevent adverse remodeling and development of heart failure. The study was a multi-center, prospective, randomized, controlled study evaluating the feasibility of pacing after a heart attack. The study was carried out in the United States, Europe, and the Middle East. Due to the precision required to accurately place the device in the infarcted area, only highly skilled Electrophysiologist were invited to participate in the study.

Electrophysiologist in the United States involved in the PROMPT study were affiliated with Emory University, University of Pennsylvania, Cleveland Clinic, Massachusetts General. Amongst this group was Arizona Arrhythmia Consultants. Arizona Arrhythmia Consultants was ranked among the top 5 centers in regards to enrollment and successfully carrying out the protocol. The study was locally led by Thomas Mattioni MD from Arizona Arrhythmia Consultants. “This clinical trial was well designed to study an important potential therapy to prevent a major disease process in individuals who have suffered a large heart attack. Unfortunately, there was no clear benefit of this potential therapy for our patients.”

The PROMPT study followed patients for 18 months and concluded that pacing in the peri-infarct area did not prevent adverse remodeling after a heart attack.

Arizona Arrhythmia Consultants is committed to offering patients state of the art technology. “Major advances in arrhythmia management have been made possible by scientific study and participation of patients. Arizona Arrhythmia Consultants has been able to offer state-of-the-art therapy options to our patients due to our on-going research endeavors”, said Dr. Mattioni http://www.aacheart.com/index.html

For further information or interview please contact Stacey Rorvig at srorvig@aacheart.com. Office: 480-246-3015

Written by Deandra O'Connor.

Reference

1.     Lloyd-Jones, D., et al., Heart disease and stroke statistics -2010 update: a report from the American Heart Association. Circulation. 2010. 121(7): p. e46-e215.
2.    Epstein, A.E., et al., ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practive Guidelines (Writing Committee to Revise the ACC?AHA?NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracis Surgeons. Circulatio, 2008. 117(21): p. 350-408.
3.    Chan, KL,. Et al., Functional and echocardiographic improvement following multisite biventricular pacing for congestive heart failure. Can J Cardiol, 2003. 19(4): p. 387-390.
4.    Ukkonen, H., et al., Effects of cardiac reshychronization on myocardial efficiency and regional oxidative metabolism. 2003. 107(1): p. 28-31.
5.    St John Sutton, MG., et al., Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure. Circulation, 2003. 107(15)L o,1985-1990.

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