Cardiac contractility modulation: first experience in heart failure patients with reduced ejection fraction and permanent atrial fibrillation

Röger, Susanne; Schneider, Raphaela; Rudic, Boris; Liebe, Volker; Stach, Ksenija; Schimpf, Rainer; Borggrefe, Martin; Kuschyk, Jürgen

doi:10.1093/europace/euu050

Cited by 30 publications

(17 citation statements)

References 24 publications

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“…The experience to-date includes patients with NYHA classes II, III and IV symptoms, mostly with narrow QRS, but some also with wide QRS, after being treated by CRT. At present, the device can deliver the therapy to patients that are not in permanent atrial fibrillation, even though a preliminary experience with permanent AF was published recently showing the feasibility and clinical benefit in that population as well [14].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and survival in patients with cardiac contractility modulation: Long-term single center experience in 81 patients

Kuschyk

Roeger

Schneider

et al. 2015

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Efficacy and survival in patients with cardiac contractility modulation: Long-term single center experience in 81 patients

Kuschyk

Roeger

Schneider

et al. 2015

International Journal of Cardiology

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“…Although permanent atrial fibrillation prevents the optimizer stimulus due to loss of the atrial sensing, current versions of the device can overcome this limitation, allowing effective impulse delivery in the presence of atrial fibrillation. Early experience with this novel algorithm (linked to the presence of a CRT device impulse) was published by Roger et al [61]. who described use of CCM in 5 patients who developed permanent atrial fibrillation at or after optimizer implantation.…”

Section: Device Therapy For Heart Failurementioning

confidence: 99%

Cardiac contractility modulation: a novel approach for the treatment of heart failure

Abi‐Samra¹,

Gutterman

2016

Heart Fail Rev

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Heart failure is a major health problem worldwide and, despite effective therapies, is expected to grow by almost 50 % over the next 15 years. Five-year mortality remains high at 50 % over 5 years. Because of the economic burden and large impact on quality of life, substantial effort has focused on treatments with multiple medical (beta-blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ARB), aldosterone antagonists, and combination of ARB/neprilysin blockers, ivabradine) and device therapies (ICD, CRT) which have been implemented to reduce disease burden and mortality. However, in the past decade only two new medical therapies and no devices have been approved by the US FDA for the treatment of heart failure. This review highlights the preclinical and clinical literature, and the implantation procedure, related to a relatively new therapeutic device for heart failure; cardiac contractility modulation (CCM). CCM delivers a biphasic high-voltage bipolar signal to the RV septum during the absolute refractory period, eliciting an acute increase in global contractility, and chronically producing a sustained improvement in quality of life, exercise tolerance, and heart failure symptoms. The technology is used commercially in Europe with nearly 3000 patients implanted worldwide. Indications include patients with reduced EF and normal or slightly prolonged QRS duration, thus filling an important therapeutic gap among the 2/3 of patients with heart failure who do not meet criteria for CRT. The mechanism by which CCM provides benefit can be seen at the cellular level where improved calcium handling (phosphorylation of phospholamban, upregulation of SERCA-2A), reversal of the fetal myocyte gene program associated with heart failure, and reverse remodeling are observed. Recent retrospective studies indicate a long-term mortality benefit. A pivotal randomized controlled study is currently being completed in the USA. CCM appears to be an effective, safe technology for the treatment of heart failure with reduced ejection fraction.

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“…The new‐generation Optimizer, the Optimizer Smart, includes an algorithm that does not require the implantation of an atrial lead (keeping the 2 ventricular leads only), thereby further simplifying the implantation procedure. The new mode also allows the delivery of CCM therapy in patients with permanent atrial fibrillation, which was considered a contraindication for the prior‐generation Optimizer device . In a recent study, it was demonstrated that efficacy and safety of CCM were similar when the signal was delivered through either 1 or 2 ventricular leads .…”

Section: Discussionmentioning

confidence: 99%

“…The new mode also allows the delivery of CCM therapy in patients with permanent atrial fibrillation, which was considered a contraindication for the prior-generation Optimizer device. 21 In a recent study, it was demonstrated that efficacy and safety of CCM were similar when the signal was delivered through either 1 or 2 ventricular leads. 22 These results support the potential future use of a single ventricular lead for delivery of CCM, further reducing device implantation-associated risk.…”

Section: Discussionmentioning

confidence: 99%

Long‐term results of combined cardiac contractility modulation and subcutaneous defibrillator therapy in patients with heart failure and reduced ejection fraction

Röger

Rudic

Akın

et al. 2018

Clinical Cardiology

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BackgroundCardiac contractility modulation (CCM) is an electrical‐device therapy for patients with heart failure with reduced ejection fraction (HFrEF). Patients with left ventricular ejection fraction (LVEF) ≤35% also have indication for an implantable cardioverter‐defibrillator (ICD), and in some cases subcutaneous ICD (S‐ICD) is selected.HypothesisCCM and S‐ICD can be combined to work efficaciously and safely.MethodsWe report on 20 patients with HFrEF and LVEF ≤35% who received CCM and S‐ICD. To exclude device interference, patients received intraoperative crosstalk testing, S‐ICD testing, and bicycle exercise testing while CCM was activated. Clinical and QOL measures before CCM activation and at last follow‐up were analyzed. S‐ICD performance was evaluated while both CCM and S‐ICD were active.ResultsMean follow‐up was 34.3 months. NYHA class improved from 2.9 ± 0.4 to 2.1 ± 0.7 (P < 0.0001), Minnesota Living With Heart Failure Questionnaire score improved from 50.2 ± 23.7 to 29.6 ± 22.8 points (P < 0.0001), and LVEF improved from 24.4% ± 8.1% to 30.9% ± 9.6% (P = 0.002). Mean follow‐up time with both devices active was 22 months. Three patients experienced a total of 6 episodes of sustained ventricular tachycardia, all successfully treated with first ICD shock. One case received an inappropriate shock unrelated to the concomitant CCM. One patient received an LVAD, so CCM and S‐ICD were discontinued.ConclusionsCCM and S‐ICD can be successfully combined in patients with HFrEF. S‐ICD and CCM remain efficacious when used together, with no interference affecting their function.

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Cardiac contractility modulation: first experience in heart failure patients with reduced ejection fraction and permanent atrial fibrillation

Cited by 30 publications

References 24 publications

Efficacy and survival in patients with cardiac contractility modulation: Long-term single center experience in 81 patients

Efficacy and survival in patients with cardiac contractility modulation: Long-term single center experience in 81 patients

Cardiac contractility modulation: a novel approach for the treatment of heart failure

Long‐term results of combined cardiac contractility modulation and subcutaneous defibrillator therapy in patients with heart failure and reduced ejection fraction

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