Cardiac Contractility Modulation as a Novel Therapy for Patients with Heart Failure

Abstract

AbstractCardiac contractility modulation (CCM) is a novel cardiac stimulation technique based on a biphasic high-voltage electric current delivered directly to the myocardium during the absolute refractory period. CCM causes an increase in regional and global heart contractility and improves exercise tolerance, quality of life and decreases heart failure (HF) symptoms. Despite numerous medical achievements HF continues to be a tremendous clinical, social, and economic problem. Many pharmacological agents as well as implantable devices have been proposed to treat HF. The first attempts with CCM technology go the end of the 1990s but the first-in-human implantation took place in 2001. Typically a patient with left ventricle ejection fraction of EF 25–45% and NYHA Class II–III is a perfect match for CCM therapy. It optimizes calcium handling and causes stronger contraction of cardiomyocytes. Over a dozen clinical trials have been conducted to show the impact of CCM therapy on variety of parameters in patients suffering from HF. The implantation technique is similar to that of pacemakers or ICDs. CCM seems to be a safe and effective pacing modality for selected patients with HF.