Clinical effects of cardiac contractility modulation (CCM) as a treatment for chronic heart failure

@article{Borggrefe2012ClinicalEO,
  title={Clinical effects of cardiac contractility modulation (CCM) as a treatment for chronic heart failure},
  author={Martin Borggrefe and Daniel Burkhoff},
  journal={European Journal of Heart Failure},
  year={2012},
  volume={14}
}
Cardiac contractility modulation (CCM) signals are non‐excitatory signals applied during the absolute refractory period that have been shown to enhance the strength of left ventricular contraction without increasing myocardial oxygen consumption in studies carried out in animals and humans with heart failure and reduced ejection fraction. Studies from myocardial tissue of animals and humans with heart failure suggest that the mechanisms of these effects is that CCM drives expression of many… Expand
Cardiac contractility modulation: mechanisms of action in heart failure with reduced ejection fraction and beyond
TLDR
Cardiac contractility modulation (CCM) signals have been shown to improve symptoms, exercise tolerance and quality of life and reduce the rate of HF hospitalizations in patients with ejection fractions (EF) between 25% and 45%. Expand
Cardiac Contractility Modulation in Patients with Heart Failure with Reduced Left Ventricular Ejection Fraction
TLDR
Cardiac contractility modulation could have a place in therapy and meet a relevant medical need for a specific sub-category of underserved heart failure patients with reduced left ventricular ejection fraction, according to multiple clinical and mechanistic studies. Expand
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TLDR
The evidence for the use of cardiac contractility modulation (CCM) is reviewed and in which patients it may be considered as recommended in the recent guidelines is discussed and an individual patient data meta- analysis of all the randomised controlled trials of CCM is discussed. Expand
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TLDR
The aim of this review is to summarize the pathophysiological mechanisms, the current indications, and the recent developments regarding the new applications of the CCM for patients with chronic heart failure. Expand
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TLDR
Cardiac contractility modulation provides safe and effective long-term symptomatic and functional improvement in heart failure and were associated with a safety profile similar to published device trials. Expand
A randomized comparison of 5 versus 12 hours per day of cardiac contractility modulation treatment for heart failure patients: A preliminary report.
TLDR
Evaluating the quality of life, exercise tolerance, and cardiac function in 19 medically refractory symptomatic patients with heart failure and reduced left ventricular function concluded that increasing the daily CCM therapy duration is safe and as good as the standard CCM periods of application per day. Expand
Cardiac contractility modulation: a novel approach for the treatment of heart failure
TLDR
CCM appears to be an effective, safe technology for the treatment of heart failure with reduced ejection fraction, filling an important therapeutic gap among the 2/3 of patients with heart failure who do not meet criteria for CRT. Expand
Cardiac contractility modulation: first experience in heart failure patients with reduced ejection fraction and permanent atrial fibrillation.
  • S. Röger, R. Schneider, +5 authors J. Kuschyk
  • Medicine
  • Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
  • 2014
TLDR
CCM signal Delivery is feasible in HF patients with permanent AF by sequential atrial-ventricular pacing, so that the atrial pacing spike is interpreted as a p wave by the CCM signal delivery algorithm. Expand
Long term impact of cardiac contractility modulation on QRS duration.
TLDR
CCM prevents chronic ventricular depolarization delay that occurs in heart failure and that is associated with poorer outcomes and suggests a possible long-term benefit in maintaining QRS duration. Expand
Cardiac contractility modulation treatment in patients with symptomatic heart failure despite optimal medical therapy and cardiac resynchronization therapy (CRT).
TLDR
Patients with heart failure and reduced ejection fraction who remain moderately to severely symptomatic despite use of CRT, may benefit from CCM therapy with improvement in quality of life and exercise tolerance. Expand
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References

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Does Contractility Modulation Have a Role in the Treatment of Heart Failure?
TLDR
A review of clinical studies investigating the impact of Cardiac contractility modulation on exercise tolerance and quality of life in patients with chronic heart failure outlines additional studies underway to further clarify the role of CCM in the treatment of heart failure. Expand
Cardiac Contractility Modulation With the Impulse Dynamics Signal: Studies in Dogs With Chronic Heart Failure
TLDR
Pre-clinical results to date with the Impulse Dynamics CCM signal indicate that this non-pharmacologic therapeutic modality can provide short-term positive inotropic support to the failing heart and as such, may be a useful adjunct in the treatment of advanced heart failure. Expand
Therapy with cardiac contractility modulation electrical signals improves left ventricular function and remodeling in dogs with chronic heart failure.
TLDR
In dogs with HF, long-term CCM therapy improves LV systolic function and the improvements are additive to those seen with beta-blockers. Expand
Electrical Modulation of Cardiac Contractility: Clinical Aspects in Congestive Heart Failure
TLDR
The study suggests that unlike modified pacing techniques, delivery of the signal to the left ventricle during the refractory period resulted in a rapid increase in myocardial contractility and improved hemodynamic performance. Expand
Enhanced inotropic state of the failing left ventricle by cardiac contractility modulation electrical signals is not associated with increased myocardial oxygen consumption.
TLDR
The study results suggest that unlike cAMP-dependent positive inotropic drugs, the increase in LV function during CCM therapy is elicited without increasing MVO(2). Expand
Electrical signals applied during the absolute refractory period: an investigational treatment for advanced heart failure in patients with normal QRS duration.
TLDR
Two prospective, randomized clinical studies are currently underway to definitively test the safety and efficacy of cardiac contractility modulating signals, and it is suggested that CCM signals can enhance the strength of left ventricular contraction. Expand
Cardiac contractility modulation electrical signals improve myocardial gene expression in patients with heart failure.
TLDR
The CCM signal treatment reverses the cardiac maladaptive fetal gene program and normalizes expression of key sarcoplasmic reticulum Ca(2+) cycling and stretch response genes. Expand
Cardiac contractility modulation with nonexcitatory electric signals improves left ventricular function in dogs with chronic heart failure.
TLDR
In dogs with HF, CCM signal delivery for 6 hours elicited marked improvement in LV function, suggesting this novel approach may represent a useful adjunctive therapy for the treatment of patients with HF. Expand
Nonexcitatory, cardiac contractility modulation electrical impulses: feasibility study for advanced heart failure in patients with normal QRS duration.
TLDR
Despite a sicker population in the treatment group, no specific safety concerns emerged with chronic cardiac contractility modulation signal administration and further study is required to definitively define the safety and efficacy of cardiac contractile modulation signals. Expand
Chronic electrical stimulation during the absolute refractory period of the myocardium improves severe heart failure.
TLDR
Preliminary data indicate that CCM by delivery of intermittent nonexcitatory electrical stimuli is a promising technique for improving ventricular systolic function and symptoms in patients with drug-refractory NYHA class III heart failure. Expand
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