Cardiac contractility modulation. A new form of therapy for patients with heart failure and narrow QRS complex?

• Published in: Herz Vol. 40; no. 7; pp. 945 - 951
• Main Author: Kleemann, T
• Format: Journal Article
• Language: German; English
• Published: Germany 01.11.2015
• Subjects: Cardiac Pacing, Artificial - methods; Cardiac Pacing, Artificial - trends; Chronic Disease; Evidence-Based Medicine; Heart Failure - complications; Heart Failure - diagnosis; Heart Failure - prevention & control; Humans; Technology Assessment, Biomedical; Treatment Outcome; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - prevention & control; Heart failure; Electric stimulation therapy; Peak oxygen consumption; Cardiac contractility modulation; Quality of life
• ISSN: 0340-9937; 1615-6692
• DOI: 10.1007/s00059-015-4362-8

Cardiac contractility modulation (CCM) is a stimulation therapy by an implantable impulse generator, which enhances ventricular contractile performance by delivering CCM impulses to the right ventricle during the absolute refractory period. The CCM signals mediate increased inotropy by prolonging the duration of the action potential, which leads to an enhanced influx of calcium into cardiomyocytes and a greater release of calcium by the sarcoplasmic reticulum. The increase of cardiac contractility is not associated with increased oxygen consumption. Several small studies have shown that CCM therapy can safely improve symptoms of heart failure and peak oxygen consumption in patients with moderate to severe heart failure who are not eligible for resynchronization therapy. Therefore, CCM is a novel potential therapy for patients with heart failure, an ejection fraction ≤ 35 % and a normal QRS duration < 130 ms. However, apart from selecting appropriate patients for CCM therapy there are still unanswered questions, such as the impact of CCM therapy on established clinical endpoints. At present no data are available which have shown that CCM therapy leads to reduction of hospitalization for heart failure or mortality.