Cardiac contractility modulation for patient with refractory heart failure: an updated evidence-based review
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Cardiac contractility modulation for patient with refractory heart failure: an updated evidence-based review Luigi Cappannoli 1 & Roberto Scacciavillani 1 & Erica Rocco 1 & Francesco Perna 1,2 & Maria Lucia Narducci 1,2 & Marcello Vaccarella 1,2 & Domenico D’Amario 1,2 & Gemma Pelargonio 1,2 & Massimo Massetti 1 & Filippo Crea 1,2 & Nadia Aspromonte 1,2 Accepted: 16 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Heart failure is the cardiovascular epidemic of the twenty-first century, with poor prognosis and quality of life despite optimized medical treatment. Despite over the last decade significant improvements, with a major impact on morbidity and mortality, have been made in therapy for heart failure with reduced ejection fraction, little progress was made in the development of devices, with the implantable defibrillator indicated for patients with left ventricle ejection fraction ≤ 35% and cardiac resynchronization therapy for those with QRS ≥ 130 ms and evidence of left bundle branch block. Nevertheless, only a third of patients meet these criteria and a high percentage of patients are non-responders in terms of improving symptoms. Nowadays, in patients with symptomatic heart failure with ejection fraction between 25% and 45% and QRS < 130 ms, not eligible for cardiac resynchronization, the cardiac contractility modulation (CCM) represents a concrete therapeutic option, having proved to be safe and effective in reducing hospitalizations for heart failure and improving symptoms, functional capacity, and quality of life. The aim of this review is therefore 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. Keywords Cardiac contractility modulation . Heart failure . Implantable device . Atrial fibrillation
Introduction Heart failure (HF) represents the twenty-first century cardiovascular epidemic, with over 25 million cases worldwide [1]. The increase in HF cases is partly ascribable to the “paradoxical” success in treating acute coronary syndromes, with a consequent reduction in mortality and higher incidence of cardiac dysfunction among the survivors, partly due to the increase in longevity and, and finally, to the growing incidence of obesity and diabetes cases, which have led to a growing number of cases of heart failure with preserved ejection fraction (HFpEF) [2].
* Nadia Aspromonte [email protected] 1
Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, Italy
2
Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
The prognosis of patients with HF remains poor, with one in nine patients dying 1 year after diagnosis and about one half within 5 years, and, despite appropriate medical treatment, many patients have frequent hospitalizations and reduced quality of life [3]. Furthermore, even when symptoms are con
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