Long‐term clinical experience with cardiac contractility modulation therapy delivered by the Optimizer Smart system

Abstract

We assessed long-term effects of cardiac contractility modulation delivered by the Optimizer Smart system on quality of life, left ventricular ejection fraction (LVEF), mortality and heart failure and cardiovascular hospitalizations.

Use of Cardiac Contractility Modulation as Bridge to Transplant in an Obese Patient With Advanced Heart Failure: A Case Report

“…Recent results from the largest published registry to date, CCM-REG25-45, showed that the survival rates of patients with LVEF <35% were significantly higher than the survival predicted by the SHFM ( p = 0.46) ( 15 ).…”

Use of Cardiac Contractility Modulation in an Older Patient with Non-Ischemic Dilated Cardiomyopathy: A Case Report

“…These two mechanisms justify the improvement in cardiac contractility (in the absence of increased myocardial oxygen consumption) that CCM therapy should be used for patients with HFrEF [ 10 ]. CCM therapy was associated with improvements in exercise tolerance (both the distance covered in the 6-min walking distance test and the VO 2 peak in the cardiopulmonary exercise test), an increase in quality of life, a reduction in HF hospitalizations, and reverse remodelling of the left ventricle (reduction in left ventricular volumes and increase in LVEF) [ 5 , 11 , 12 ]. The current guidelines on the diagnosis and management of acute and chronic heart failure by the European Society of Cardiology [ 3 ] state that CCM should be considered in patients with HF, NYHA class III–IV HFs, an LVEF ≥25% to ≤45%, and a QRS duration <130 ms.…”

“…The patient was treated with intravenous diuretics and levosimendan and achieved a euvolemia state after three days of admission with a reduction in NT-proBNP to 976.8 pg/mL. According to ESC guidelines on the management of chronic and acute HF and the results of DANISH trials [5], given the low risk of arrhythmic sudden cardiac death of the patient, we did not opt for ICD implantation; instead, to reduce HF-related hospitalizations and to improve quality of life, The NT-proBNP value was 1305.4 pg/mL, and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) score was 82 points. The patient was treated with intravenous diuretics and levosimendan and achieved a euvolemia state after three days of admission with a reduction in NT-proBNP to 976.8 pg/mL.…”

“…The patient was treated with intravenous diuretics and levosimendan and achieved a euvolemia state after three days of admission with a reduction in NT-proBNP to 976.8 pg/mL. According to ESC guidelines on the management of chronic and acute HF and the results of DANISH trials [ 5 ], given the low risk of arrhythmic sudden cardiac death of the patient, we did not opt for ICD implantation; instead, to reduce HF-related hospitalizations and to improve quality of life, we decided to implant a CCM therapy device. After signing informed consent, the Optimizer Smart ® (Impulse Dynamics, Marlton, NJ, USA) for the delivery of CCM therapy was implanted ( Figure 2 ).…”

“…However, only one-third of patients with HFrEF meet these criteria and 30% are non-responders after CRT implantation [ 4 ]. In patients with symptomatic HF despite OMT, LVEFs between 25% and 45%, and who are not eligible for CRT, randomized clinical trials and clinical registry have shown that cardiac contractility modulation (CCM) therapy represents a valid therapeutic option in improving exercise capacity and quality of life, in alleviating HF-related symptoms, and in reducing HF-related hospitalizations [ 5 , 6 ]. In this case, we show the use of CCM therapy in an older patient with dilated cardiomyopathy due to non-ischemic aetiology without indication to CRT, demonstrating the clinical benefit of this novel HF device-based therapy.…”