Nonexcitatory, cardiac contractility modulation electrical impulses: Feasibility study for advanced heart failure in patients with normal QRS duration

Neelagaru, Suresh; Sánchez, Javier; Lau, Stanley K.; Greenberg, Steven M.; Raval, Nirav; Worley, Seth J.; Kalman, Jill; Merliss, Andrew; Krueger, Steven K.; Wood, Mark A.; Wish, Marc; Burkhoff, Daniel; Nademanee, Koonlawee

doi:10.1016/j.hrthm.2006.06.031

Cited by 86 publications

(73 citation statements)

References 27 publications

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“…CCM is a novel approach for increasing the contractility of ventricular muscle by delivering non-excitatory electrical signals [16,17] . Since the reduced intracellular calcium results in decreased contractile performance in heart failure, CCM may provide a means to enhance pump function in patients with normal QRS duration [18,19] and those who fail to respond to resynchronization therapy [20,21] . CCM did not increase oxygen consumption [22] .…”

Section: Discussionmentioning

confidence: 99%

Effects of electric stimulations applied during absolute refractory period on cardiac function of rabbits with heart failure

Haizhu

Cui

2010

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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The effects of electric currents applied during absolute refractory period (ARP) on the cardiac function of rabbits with heart failure due to myocardial infarction (MI), and the safety of this method were investigated. Thirty rabbits were randomly assigned equally to 3 groups: sham-operated group, LV-anterior wall cardiac contractility modulation (LV-CCM) group, and septum-CCM (S-CCM) group. A thoracotomy was performed on all the rabbits. Electric pulses were delivered during the ARP on the anterior wall of left ventricle in CCM group and in the septum in S-CCM group, respectively. The left ventricular systolic pressure (LVSP) and maximum positive left ventricular pressure change (+dp/dt(max)), heart rates, ventricular tachycardia, ventricular fibrillation were observed. It was found that, as compared with the baseline, LVSP, and +dp/dtmax were significantly increased, on average, by 15.2% and 19.5% in LV-CCM group (P<0.05), and by 8.5% and 10.8% in S-CCM group (P<0.05). LVEDP was significantly decreased and -dp/dt(max) increased both in LV-CCM group and S-CCM group (P<0.05). CCM had no effect on heart rate and induced no arrhythmia in short time. It is concluded that electric currents delivered during the ARP could significantly enhance the contractility of myocardium safely, suggesting that CCM stimulation is a novel potent method for contractility modulation.

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Section: Discussionmentioning

confidence: 99%

Effects of electric stimulations applied during absolute refractory period on cardiac function of rabbits with heart failure

Haizhu

Cui

2010

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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“…Enrollment has focused on patients with symptomatic (NYHA II-IV) heart failure with reduced ejection fraction (typically 35% or less) and without prolonged QRS duration. Results from the three major randomized controlled clinical trials (FIX-HF-4, FIX-HF-5, and FIX-HF-5-pilot) [7,14,15] have been compiled into a meta-analysis based on collective analysis of individual data (Figure 4). [2] Exercise tolerance (peak VO 2 ), walking distance (6 min walk test), and quality of life (Minnesota living with heart failure questionnaire; MLWHFQ) were assessed across 641 individual subjects from the three trials.…”

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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“…The patients were characterized by a disease severity of NYHA class III and a left ventricular ejection fraction of ≥ 25% [25,26]. Cardiac contractility modulation has proven to be effective and safe in randomized controlled trials involving several hundred patients [27][28][29][30]. Metaanalyses studying the efficacy of CCM therapy on heart failure [24,31], showed that CCM significantly improved important markers of cardiac performance including the maximal oxygen uptake (peak VO2 or pVO2 -measured by ventilatory parameters during a cardiopulmonary exercise test), which is indicative of improved survival [32] and the 6-minute walk test.…”

Section: Cardiac Contractility Modulation (Ccm)mentioning

confidence: 99%

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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Nonexcitatory, cardiac contractility modulation electrical impulses: Feasibility study for advanced heart failure in patients with normal QRS duration

Cited by 86 publications

References 27 publications

Effects of electric stimulations applied during absolute refractory period on cardiac function of rabbits with heart failure

Effects of electric stimulations applied during absolute refractory period on cardiac function of rabbits with heart failure

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

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

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