Abstract

The review analyzes new treatment for patients with chronic heart failure (CHF) with low ejection fraction – cardiac contractility modulation (CCM). CCM is carried out by supplying electric signals to an absolutely refractory ventricular myocardium, to elicit a positive inotropic effect without increasing myocardial oxygen consumption. These effects are independent on QRS duration; consequently, the therapy might be beneficial for patients who are not candidates for cardiac resynchronization therapy (CRT). It should be noted that the use of CCM treatment of CHF should begin only with maximum active therapy when its efficacy is not enough. It is not an alternative, but complement to the most active treatment of patients. Clinical studies primarily focused on patients with normal QRS duration because the CPT is optimal treatment of patients with prolonged QRS. The article focuses on the prerequisites for the development of the method and discusses the results obtained when evaluating the clinical efficacy and safety of treatment of patients with CHF in randomized clinical trials FIX-HF-3 (n=25), FIX-HF-4 (n=164), FIX-HF-5 (n=428). The total number of patients included into these studies was 617 people. Baseline patient characteristics were similar for all 3 studies. All participants received optimal medical therapy, had a normal QRS duration. All patients were II and III functional class (by NYHA). The studies analyzed the changes in NYHA class, ejection fraction, peak oxygen consumption (VO2), the precursor of brain natriuretic peptide (NT-proBNP) level. Quality of life was assessed by the Minnesota questionnaire; the mortality rate was compared with that predicted by MAGGIC scale. CCM therapy had beneficial effect on the survival and quality of life in patients with CHF. However, more data is needed to assess long-term effects of the CCM therapy.

Highlights

  • Обзор анализирует новый метод лечения больных c хронической сердечной недостаточностью (ХСН) и низкой фракцией выброса – модуляцию сердечных сокращений (МСС)

  • contractility modulation (CCM) is carried out by supplying electric signals to an absolutely refractory ventricular myocardium, to elicit a positive inotropic effect without increasing myocardial oxygen consumption. These effects are independent on QRS duration; the therapy might be beneficial for patients who are not candidates for cardiac resynchronization therapy (CRT)

  • It should be noted that the use of CCM treatment of chronic heart failure (CHF) should begin only with maximum active therapy when its efficacy is not enough

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Summary

ИННОВАЦИОННАЯ КАРДИОЛОГИЯ

Модуляция сердечной сократимости – новый метод в терапии сердечной недостаточности. Ангелина Анатольевна Петрухина*, Сергей Николаевич Терещенко, Игорь Витальевич Жиров. Что применение МСС для лечения ХСН должно начинаться только на фоне максимально активной терапии при ее недостаточной эффективности. The review analyzes new treatment for patients with chronic heart failure (CHF) with low ejection fraction – cardiac contractility modulation (CCM). CCM is carried out by supplying electric signals to an absolutely refractory ventricular myocardium, to elicit a positive inotropic effect without increasing myocardial oxygen consumption These effects are independent on QRS duration; the therapy might be beneficial for patients who are not candidates for cardiac resynchronization therapy (CRT). For citation: Petrukhina A.A., Tereshchenko S.N., Zhirov I.V. Modulation of Cardiac Contractility – a New Method in the Treatment of Heart Failure. В то же время произошла революция в разработке новых способов для лечения сердечной недостаточности – появились такие устройства, как сердечная ресинхронизирующая терапия (СРТ), имплантируемый кардиовертер-дефибрилятор (ИКД) и модуляция сердечной сократимости (МСС), которые представляют дополнительные возможности для облегчения симптоматики у пациентов, резистентных к лекарственной терапии. Таким инновационным методом лечения пациентов с ХСН может послужить МСС

Механизм действия модуляции сердечной сократимости
Техника имплантации
Findings
Влияние на энергетический обмен миокарда
Full Text
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