The emerging role of cardiac contractility modulation in heart failure treatment

Abstract

Purpose of reviewHeart failure often progresses despite optimal medical and device therapies, and advanced mechanical circulatory support has limited availability and substantial associated morbidity. Cardiac contractility modulation (CCM) provides nonexcitatory stimulation to ventricular myocardium which increases cardiac contractility without increasing oxygen demand. This review describes the emerging role of CCM in heart failure treatment. Recent findingsThe FIX-HF-5C2 study demonstrated similar safety and efficacy profile of the two-lead Optimizer device in comparison with the prior three-lead system, thereby decreasing procedural complexity and minimizing endocardial hardware. The FIX-HF-5C trial underscored the benefit of CCM in patients with mild-moderate left ventricular dysfunction (ejection fraction, 25-45%) with New York Heart Association (NYHA) Class III symptoms. The summarized randomized trial data show consistent improvements in peak VO 2 , 6-min walk distance, and NYHA functional class with CCM. Future trials are planned to determine the role of CCM in heart failure patients with preserved ejection fraction, obligate ventricular pacing, and atrial arrhythmias. SummaryNonexcitatory extracellular electric potentials can facilitate inotropic improvements in the failing heart. The mechanism of CCM does not increase myocardial oxygen consumption and has been shown to mitigate heart failure symptoms, decrease hospitalizations, and work in synergy with guideline-directed therapy for heart failure.

A Multistep Approach to Deal With Advanced Heart Failure: A Case Report on the Positive Effect of Cardiac Contractility Modulation Therapy on Pulmonary Pressure Measured by CardioMEMS

“…The Optimizer unit was then attached to the leads and located in the pocket ( Figure 2 ). The Optimizer pulse generator needs manual transcutaneous recharging by the patient: routine recharging is done weekly and needs about 1 h to complete ( 11 ). In our case, the CCM therapy was scheduled for 10 h/day ( Figure 3 ).…”

Enhancing myocardial function with cardiac contractility modulation: potential and challenges

“…The FIX‐HF‐5C trial compared the previous three‐lead system with the two‐lead Optimizer device, demonstrating similar safety and efficacy profiles 66 . This study also found that CCM reduced NYHA class III symptoms in patients with mild–moderate LV dysfunction (EF 25–45%) 66 .…”

Device-based therapies for decompensated heart failure

“…Impulse Dynamics received FDA approval in 2019 for patients with ejection fraction between 25% and 40% with continued NYHA class III symptoms despite guideline directed medical therapy (GDMT) who do not have an indication for CRT. A recent review highlighted improvements in CCM therapy [19 ▪ ]. An observational analysis in the MAINTAINED study population showed relatively greater improvement in ejection fraction at 3 and 5 years postdevice implant in nonischemic versus ischemic patients [20].…”