New Generation Cardiac Contractility Modulation Device-Filling the Gap in Heart Failure Treatment.

Diana Tint,Roxana Florea,Sorin Micu

doi:10.3390/jcm8050588

Abstract

(1) Background: Heart failure (HF) is a major cause of morbidity and mortality throughout the world. Despite substantial progress in its prevention and treatment, mortality rates remain high. Device therapy for HF mainly includes cardiac resynchronization therapy (CRT) and the use of an implantable cardioverter-defibrillator (ICD). Recently, however, a new device therapy—cardiac contractility modulation (CCM)—became available. (2) Aim: The purpose of this study is to present a first case-series of patients with different clinical patterns of HF with a reduced ejection fraction (HFrEF), supported with the newest generation of CCM devices. (3) Methods and results: Five patients with a left ventricular ejection fraction (LVEF) ≤ 35% and a New York Heart Association (NYHA) class ≥ III were supported with CCM OPTIMIZER® SMART IPGCCMX10 at our clinic. The patients had a median age of 67 ± 8.03 years (47–80) and were all males—four with ischemic etiology dilated cardiomyopathy. In two cases, CCM was added on top of CRT (non-responders), and, in one patient, CCM was delivered during persistent atrial fibrillation (AF). After 6 months of follow-up, the LVEF increased from 25.4 ± 6.8% to 27 ± 9%, and the six-minute walk distance increased from 310 ± 65.1 m to 466 ± 23.6 m. One patient died 47 days after device implantation. (4) Conclusion: CCM therapy provided with the new model OPTIMIZER® SMART IPG CCMX10 is safe, feasible, and applicable to a wide range of patients with HF.

Highlights

Heart failure (HF) is a major cause of morbidity and mortality throughout the world [1]
(2) Aim: The purpose of this study is to present a first case-series of patients with different clinical patterns of HF with a reduced ejection fraction (HFrEF), supported with the newest generation of contractility modulation (CCM) devices
Most of them were New York Heart Association (NYHA) class III at the time of the intervention, and all of them were in sinus rhythm

Summary

Introduction

Heart failure (HF) is a major cause of morbidity and mortality throughout the world [1]. HF device therapy includes cardiac resynchronization therapy (CRT) for patients with a left ventricular ejection fraction (LVEF) ≤ 35% and a wide QRS (QRS of 130 msec or longer, optimum > 150 msec) and an implantable cardioverter-defibrillator (ICD) for all patients with a LVEF ≤ 35%. These therapies have been validated in solid clinical trials [2,3,4,5] and were included in the recent heart failure guidelines with a class I indication [6]. One-third of patients receiving CRT are non-responders, they remain symptomatic, despite the GDMT [8,9,10]

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Results

Conclusion