Cardiac Contractility Modulation for Heart Failure Management

Patient Selection and Pre-Implantation Assessment

The European Society of Cardiology recommends that patients with heart failure should be on maximally tolerated doses of ACE inhibitors/ARBs, beta-blockers, and mineralocorticoid receptor antagonists for ≥3 months before considering Cardiac Contractility Modulation (CCM) implantation 1, 2
Patients with LVEF ≤35% and meeting criteria should receive an Implantable Cardioverter-Defibrillator (ICD) for primary prevention, as recommended by the European Heart Journal 1, 3
The American Heart Association suggests measuring QRS duration to exclude Cardiac Resynchronization Therapy (CRT) candidacy, as CRT is a Class I recommendation for LVEF ≤35%, QRS ≥150 ms with LBBB, and NYHA class II-IV 1, 2
Active infection or recent cardiac surgery within 40 days is a contraindication for CCM implantation, as stated in the European Heart Journal 1
Life expectancy <1 year due to non-cardiac comorbidities is a contraindication for CCM implantation, according to Circulation 2

The European Heart Journal recommends initial assessment within 1 month post-implant to verify appropriate CCM signal delivery and regular follow-up every 3-6 months to optimize device programming and assess clinical response 4
Continued medical optimization with guideline-directed medical therapy (GDMT) and regular titration to target doses is essential, as recommended by the European Heart Journal 1
Monitoring renal function and electrolytes, particularly potassium, is crucial given triple neurohormonal blockade, as stated in the European Heart Journal 1
Avoiding medications that worsen heart failure, such as NSAIDs, COX-2 inhibitors, thiazolidinediones, diltiazem, and verapamil, is recommended by the European Heart Journal 1

The American College of Cardiology notes that a Cardiac Contractility Modulation (CCM) device delivers high-voltage, long-duration electric signals to the right ventricular septal wall to augment left ventricular contractile performance in patients with heart failure 5
CCM is approved for patients with NYHA class III heart failure and left ventricular ejection fraction (LVEF) of 25% to 45% who are not candidates for cardiac resynchronization therapy (CRT) 5

Four randomized controlled trials have demonstrated benefits in exercise capacity and quality of life with CCM use, although current evidence does not yet show benefits in mortality or hospitalization rates 5
The device has been evaluated primarily in NYHA class III heart failure patients, with improvements in quality of life and exercise capacity being the primary benefits demonstrated thus far 5

Unlike cardiac resynchronization therapy (CRT), CCM works by enhancing contractility directly, and unlike implantable cardioverter-defibrillators (ICDs), CCM targets contractile function 5
CCM represents one of several device-based approaches to heart failure management, alongside CRT, ICDs, and other therapies 5