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Therapie der chronischen Herzinsuffizienz durch kardiale Kontraktionsmodulation (CCM)

Möglichkeiten und Studienübersicht

Treating congestive heart failure with cardiac contractility modulation (CCM)

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Zusammenfassung

CCM („cardiac contractility modulation“) ist eine elektrische Stimulationsform, die im Rahmen der Therapie der systolischen Herzinsuffizienz eingesetzt wird. Sie kann durch eine nichtexzitatorische Stimulation in der absoluten Refraktärperiode der Herzerregung über eine Beeinflussung des Kalziumstoffwechsels der Myokardzellen die Kontraktionskraft steigern. Dies führt zu einer Besserung der maximalen Sauerstoffaufnahme, der Lebensqualität und der Belastbarkeit der herzinsuffizienten Patienten. Die CCM-Therapie wird zusätzlich zu einem eventuell vorhandenen ICD-System durchgeführt. Aufgrund bisheriger Studiendaten wird die Therapie empfohlen für Patienten mit einer linksventrikulären Ejektionsfraktion (LVEF) von höchstens 35% und einer trotz optimaler medikamentöser Therapie symptomatischen Herzinsuffizienz (NYHA-Klasse II–III). Vorhofflimmern, eine höhergradige Extrasystolie und ein AV-Block von mehr als 300 ms sind Kontraindikationen. Bei Patienten mit einem Linksschenkelblock über 120 ms sollte zuerst die Indikation zur Implantation eines biventrikulären ICD-Systems geprüft werden.

Abstract

Cardiac contractility modulation (CCM) is a device therapy for patients with systolic heart failure. CCM therapy applies non-excitatory signals during the absolute refractory period of the heart cycle. It influences myocardial contractility by modulating the regulation of calcium cycling. CCM therapy has been proven to enhance peak VO2, quality of life and exercise tolerance in patients with congestive heart failure. It can be used as an additional therapy to an implantable cardioverter defibrillator (ICD), if present. CCM therapy should be considered in symptomatic patients with congestive heart failure, a left ventricular ejection fraction ≤35% and NYHA class II–III. Atrial fibrillation, high grade arrhythmias and an AV block of more than 300 ms represent contraindications. Patients with a left bundle branch block of >120 ms should be considered for the implantation of a biventricular ICD prior to implantation of a CCM device.

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  1. Abt. Kardiologie, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland

    T. Tönnis & K.-H. Kuck

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  1. T. Tönnis
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  2. K.-H. Kuck
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Correspondence to T. Tönnis.

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Tönnis, T., Kuck, KH. Therapie der chronischen Herzinsuffizienz durch kardiale Kontraktionsmodulation (CCM). Herz 36, 600–607 (2011). https://doi.org/10.1007/s00059-011-3510-z

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