Long-term survival with Cardiac Contractility Modulation in patients with NYHA II or III symptoms and normal QRS duration

Kloppe, Axel; Lawo, Thomas; Mijic, Dejan; Schiedat, Fabian; Muegge, Andreas; Lemke, Bernd

doi:10.1016/j.ijcard.2016.02.001

Cited by 46 publications

(25 citation statements)

References 19 publications

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“…There are reports of lower long-term mortality rates in heart failure patients with NYHA (II-III) and QRS ≤ 130 ms when treated by CCM than predicted for the cohort. These findings warrant substantiation in a prospective study [33][34][35].…”

Section: Cardiac Contractility Modulation (Ccm)mentioning

confidence: 69%

Cardiac Contractility Modulation Device and Subcutaneous Implantable Cardioverter Defibrillator Combination: A New Hope for Heart Failure Patients with Low Ejection Fraction and Narrow QRS Complex

Al‐Ghamdi¹

2016

J Cardiovasc Med Cardiol

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Section: Cardiac Contractility Modulation (Ccm)mentioning

confidence: 69%

Cardiac Contractility Modulation Device and Subcutaneous Implantable Cardioverter Defibrillator Combination: A New Hope for Heart Failure Patients with Low Ejection Fraction and Narrow QRS Complex

Al‐Ghamdi¹

2016

J Cardiovasc Med Cardiol

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“…Recent retrospective single‐center observational studies have suggested prolonged survival of HF patients treated with CCM therapy . In most of these studies, patients receiving CCM therapy had LVEF ≤35%; therefore, they also had ICD devices with intracardiac leads in place.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 A recent metaanalysis of published data found that CCM did not lower the risk of severe cardiovascular adverse events 7 ; nevertheless, retrospective observations suggest that mortality rates in patients treated with CCM, especially in those with normal QRS and with moderate disease stage, were lower than estimated by the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) model, by the Seattle Heart Failure Model (SHFM) model risk scores, or by a control group. [8][9][10] Recently, in the European Society of Cardiology (ESC) Guidelines on Acute and Chronic Heart Failure (2016), it was stated that CCM may be considered in selected patients with HF. 3 Because many patients receiving CCM have an LVEF ≤35%, an implantable cardioverter-defibrillator (ICD) is also indicated.…”

Section: Introductionmentioning

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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“…Even when correcting for the more frequent use of ICDs in the CCM cohort, mortality rates were no worse than predicted by MAGGIC. A third study was conducted across two sites in Germany by Kloppe et al [24] who followed 68 consecutive patients implanted with CCM. Patients had NYHA class II or III symptoms and EF of 26±6%.…”

Section: Effects Of Ccm On Cardiac Function and Remodelingmentioning

confidence: 99%

Other Devices for Heart Failure – Cardiac Contractility Modulation (CCM)

Coats¹

2017

ICFJ

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Substantial advances in the medical treatment of HFrEF have improved survival and cardiac function in these patients. However despite the use of optimal medical therapy (OMT) and the use of recommended devices in those in whom they are indicated, persistent symptoms limit activity and adversely affect lifestyle in a substantial number of patients. For these patients newer devices other than ICD and CRT may offer an improvement in symptoms and/or survival. This paper reviews the evidence for the use of CCM and discusses in which patients it may be considered as recommended in the recent guidelines. CCM is an established treatment in the management of moderate to severely symptomatic heart failure with reduced EF and normal QRS duration. CCM impulse delivery is associated with acute improvements in cardiac contractility. Chronic changes include reversion from fetal to adult gene expression profiles in the heart, improved calcium handling, restorative ventricular remodeling, and improved cardiac function. The recent 2016 ESC/HFA guidelines for the management of heart failure considered that most of these newer devices had insufficient clinical trial data for a formal recommendation, but in the case of one, cardiac contractility modulation (CCM) the guidelines describe CCM as being something to be considered in selected patients with HF. This is based on a demonstrated improvement in exercise tolerance (peak VO2) and quality of life (by Minnesota LWHF questionnaire, MLWHFQ) produced by CCM in an individual patient data meta- analysis of all the randomised controlled trials of CCM.

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Long-term survival with Cardiac Contractility Modulation in patients with NYHA II or III symptoms and normal QRS duration

Cited by 46 publications

References 19 publications

Cardiac Contractility Modulation Device and Subcutaneous Implantable Cardioverter Defibrillator Combination: A New Hope for Heart Failure Patients with Low Ejection Fraction and Narrow QRS Complex

Cardiac Contractility Modulation Device and Subcutaneous Implantable Cardioverter Defibrillator Combination: A New Hope for Heart Failure Patients with Low Ejection Fraction and Narrow QRS Complex

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

Other Devices for Heart Failure – Cardiac Contractility Modulation (CCM)

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