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Cardiac contractility modulation for the treatment of heart failure with reduced ejection fraction

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Abstract

There has been a progressive evolution in the management of patients with chronic heart failure and reduced ejection fraction (HFrEF), including cardiac resynchronisation therapy (CRT) in those that fulfil pre-defined criteria. However, there exists a significant proportion with refractory symptoms in whom CRT devices are not clinically indicated or ineffective. Cardiac contractility modulation (CCM) is a novel therapy that incorporates administration of non-excitatory electrical impulses to the interventricular septum during the absolute refractory period. Implantation is analogous to a traditional transvenous pacemaker system, but with the use of two right ventricular leads. Mechanistic studies have shown augmentation of left ventricular contractility and beneficial global effects on reverse remodeling, primarily through alterations in calcium handling. This appears to occur without increasing myocardial oxygen consumption. Data from clinical trials have shown translational improvements in functional capacity and quality of life, though long-term outcome data are lacking. This review explores the rationale, evidence base and limitations of this nascent technology.

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  1. Department of Cardiology, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK

    Peysh A. Patel, Ramesh Nadarajah, Noman Ali, John Gierula & Klaus K. Witte

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PAP was involved in conception and wrote the manuscript as first author. RN, NA and JG were co-authors and assisted in literature search and editing. KKW provided critical review and acted as senior author. All authors have read and approved the final submission.

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Patel, P.A., Nadarajah, R., Ali, N. et al. Cardiac contractility modulation for the treatment of heart failure with reduced ejection fraction. Heart Fail Rev 26, 217–226 (2021). https://doi.org/10.1007/s10741-020-10017-1

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