Cardiac Contractility Modulation in Heart Failure: Mechanisms and Clinical Evidence

AbstractPurpose of reviewDevice-based therapy utilizing cardiac contractility modulation (CCM ™) was approved by the FDA in March 2019 for patients with moderately to severely symptomatic heart failure with reduced ejection fraction between 25 and 45% on optimal guideline-directed medical therapy in normal sinus rhythm and not a candidate for cardiac resynchronization therapy. This review explores the mechanism of action behind CCM, the most recent clinical trials, and the expansion of therapy to additional patient populations.Recent findingsThe most recent trial on CCM explored a two-lead system, which was as equally efficacious as three-lead model. Importantly, CCM was shown to be effective in patients with atrial fibrillation (AF), who made up 15% of the population studied. Furthermore, emerging data from the European Registry suggests improvement in mortality with the use of CCM.SummaryNew developments of a two-lead system have allowed for expansion into a broader array of patient populations, including those with AF, while maintaining the safety and efficacy of this therapy.
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research

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Conclusions: IAB is associated with new-onset AF and death in CRT recipients and may be helpful in the risk stratification in the context of heart failure management. Abnormal PTFV1 did not demonstrate any prognostic value.Cardiology
Source: Cardiology - Category: Cardiology Source Type: research
Authors: Majos-Karwacka E, Kraska A, Kowalik I, Smolis-Bak E, Lipiec P, Kasprzak J, Szwed H, Dabrowski R Abstract BACKGROUND: The right ventricle (RV) function is crucial in heart failure with reduced ejection fraction (HFrEF), especially in patients with atrial fibrillation (AF). Aims. To assess the RV structure and function in patients with HFrEF, permanent atrial fibrillation (AF), cardiac resynchronization therapy (CRT) and RV pacing (RVp) with two- and three-dimensional echocardiography. Methods. Patients with ischemic HFrEF (NYHA II-III; LVEF ≤40%) were enrolled. The studied groups were: sinus rhythm (SR, ...
Source: Scandinavian Cardiovascular Journal - Category: Cardiology Tags: Scand Cardiovasc J Source Type: research
AbstractAimsThe aim of this study is to report heart failure hospitalization (HFH) rates and associated costs within 12  months following implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy defibrillator (CRT‐D) device replacement or upgrade from ICD to CRT‐D.Methods and resultsThe DEtect long ‐term COmplications after icD rEplacement (DECODE) was a prospective, single‐arm, multicentre cohort study that explored complications in ICD/CRT‐D recipients. All clinical and survival data at 12 months were prospectively analysed. For each adjudicated HFH, admission and discharge dates...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Short Communication Source Type: research
Conclusion: We selected His bundle pacing as the primary pacing, but also used left bundle branch pacing as a backup approach. If His bundle pacing results in an increased sensing threshold, pacing threshold changes, or dislocations, left bundle branch pacing can compensate for dysfunction of permanent deficiencies in His bundle pacing, preserving physiological pacing.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
AbstractIntroductionThere is a high prevalence of atrial fibrillation (AF) in patients with heart failure presented for cardiac resynchronization therapy (CRT). It remains unclear whether an atrial lead should be implanted in these patients. We, therefore, analyzed outcomes and course of rhythm in AF patients undergoing CRT implantation during long ‐term follow‐up.Methods and ResultsBetween 2004 and 2018, 328 consecutive patients with a history of AF receiving CRT implantation were included in this study. 132 patients had preoperatively paroxysmal AF (px ‐AF), while 70 and 126 patients had persistent AF (ps‐AF...
Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: ORIGINAL ‐ DEVICES Source Type: research
AbstractIntroductionThere is a high prevalence of atrial fibrillation (AF) in patients with heart failure presented for cardiac resynchronization therapy (CRT). It remains unclear whether an atrial lead should be implanted in these patients. We, therefore, analyzed outcomes and course of rhythm in AF patients undergoing CRT implantation during long ‐term follow‐up.Methods and ResultsBetween 2004 and 2018, 328 consecutive patients with a history of AF receiving CRT implantation were included into this study. 132 patients had preoperatively paroxysmal AF (px ‐AF), while 70 and 126 patients had persistent‐ (ps‐AF) a...
Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: ORIGINAL ‐ DEVICES Source Type: research
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Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: EDITORIAL ‐ INVITED Source Type: research
Background: We aimed to characterize the hourly, daily, and seasonally variations in the detection of new atrial fibrillation (AF) in heart failure (HF) patients implanted with a defibrillator.MethodsIn 1309 patients enrolled in MADIT ‐RIT without AF at baseline, atrial arrhythmia data were analyzed from device interrogations. The circadian, weekly and seasonal distribution of device detected AF was evaluated. The morning period was defined as 06:00‐11:59, afternoon as 12:00‐16:59, evening as 17:00‐22:59, and the nighttim e as 23:00‐05:59.Results: During 17 months of follow ‐up, 66 (5%) patients developed new d...
Source: Pacing and Clinical Electrophysiology : PACE - Category: Cardiology Authors: Tags: DEVICES Source Type: research
AbstractPurpose of reviewIn this review article, we aim to describe the pathophysiology of concomitant atrial fibrillation and both left and right heart failure, as well as pronounce the prognosis of having these two conditions simultaneously. This review also summarizes the current management of atrial fibrillation including stroke and thromboembolism prevention in the presence of systolic and diastolic heart failure.Recent findingsWhile rhythm control strategy is not superior to rate control strategy in atrial fibrillation patients without heart failure, catheter ablation for atrial fibrillation has shown to improve outc...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
Atrial fibrillation (AF), one of the most common comorbidities of heart failure (HF), is associated with worse long-term prognosis in HF patients receiving cardiac resynchronization therapy (CRT). However, the...
Source: BMC Cardiovascular Disorders - Category: Cardiology Authors: Tags: Research article Source Type: research
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