Cardiac contractility modulation (CCM) is a new device-based therapy for advanced systolic heart failure with normal QRS duration and therefore not suitable for cardiac resynchronization therapy (CRT). Left ventricular (LV) reverse remodeling was reported in patients treated with CCM or CRT, however, the extent of response was not compared.
This observational study consisted of three groups of patients with symptomatic heart failure and LV ejection fraction <35% despite optimal medical therapy. Group 1 included those received CCM with a QRS duration <120 ms (n=33), Group 2 included those received CRT with a QRS duration of 120–150 ms (n=43), and Group 3 included those received CRT with a QRS duration >150 ms (n=56). LV end-systolic volume (LVESV) was measured at baseline and 3 months later.
Age, gender, etiology of heart failure and baseline ejection fraction were comparable. A significant LV reverse remodeling was observed in each group. The degree of LVESV reduction was similar between Group 1 and Group 2 (−11.3±11.8 vs. −13.6±18.3%, p=0.833), however, it was greater in Group 3 (−25.0±18.0%, both p<0.01). By using the reduction ≥15%, the responder rate was not different between Group 1 (39%) and Group 2 (42%), but significantly higher in Group 3 (68%) (χ2=9.514, p=0.009).
CCM exhibited a similar LV reverse remodeling response to CRT for patients with a mildly prolonged QRS, though the effect was less strong when compared to CRT for patients with a very wide QRS.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to International Journal of Cardiology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Cardiac resynchronization in chronic heart failure.N Engl J Med. 2002; 346: 1845-1853
- Cardiac contractility modulation by non-excitatory currents: studies in isolated cardiac muscle.Eur J Heart Fail. 2006; 8: 7-15
- Cardiac contractility modulation by electric currents applied during the refractory period.Am J Physiol Heart Circ Physiol. 2002; 282: H1642-H1647
- Cardiac contractility modulation by electric currents applied during the refractory period in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.Am J Cardiol. 2002; 90: 1307-1313
- Therapy with cardiac contractility modulation electrical signals improves left ventricular function and remodeling in dogs with chronic heart failure.J Am Coll Cardiol. 2007; 49: 2120-2128
- First human chronic experience with cardiac contractility modulation by nonexcitatory electrical currents for treating systolic heart failure: mid-term safety and efficacy results from a multicenter study.J Cardiovasc Electrophysiol. 2004; 15: 418-427
- Electrical signals applied during the absolute refractory period: an investigational treatment for advanced heart failure in patients with normal QRS duration.J Am Coll Cardiol. 2005; 46: 2229-2236
- Nonexcitatory, cardiac contractility modulation electrical impulses: feasibility study for advanced heart failure in patients with normal QRS duration.Heart Rhythm. 2006; 3: 1140-1147
- Randomized, double blind study of non-excitatory, cardiac contractility modulation electrical impulses for symptomatic heart failure.Eur Heart J. 2008; 29: 1019-1028
- Impact of cardiac contractility modulation on left ventricular global and regional function and remodeling.JACC Cardiovasc Imaging. 2009; 2: 1341-1349
- Cardiac Resynchronization Therapy.2nd ed. Wiley-Blackwell, 2008
- Left ventricular reverse remodeling but not clinical improvement predicts long-term survival after cardiac resynchronization therapy.Circulation. 2005; 112: 1580-1586
- The effect of cardiac resynchronization on morbidity and mortality in heart failure.N Engl J Med. 2005; 352: 1539-1549
- Comparison of medical therapy, pacing and defibrillation in heart failure (COMPANION) trial terminated early; combined biventricular pacemaker-defibrillators reduce all-cause mortality and hospitalization.Int J Cardiol. 2003; 87: 119-120
- focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.Circulation. 2009; 119: e391-e479
- Enhanced inotropic state of the failing left ventricle by cardiac contractility modulation electrical signals is not associated with increased myocardial oxygen consumption.J Card Fail. 2007; 13: 137-142
- Results of the Predictors of Response to CRT (PROSPECT) trial.Circulation. 2008; 117: 2608-2616
- Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy.Circulation. 2006; 113: 960-968
- Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction.Circulation. 1987; 76: 44-51
- Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. MOCHA Investigators.Circulation. 1996; 94: 2807-2816
- The Carvedilol and ACE-Inhibitor Remodelling Mild Heart Failure EvaluatioN trial (CARMEN)—rationale and design.Cardiovasc Drugs Ther. 2001; 15: 69-77
- Quantitative evaluation of drug or device effects on ventricular remodeling as predictors of therapeutic effects on mortality in patients with heart failure and reduced ejection fraction: a meta-analytic approach.J Am Coll Cardiol. 2010; 56: 392-406
- Long-term effects of non-excitatory cardiac contractility modulation electric signals on the progression of heart failure in dogs.Eur J Heart Fail. 2004; 6: 145-150
- Chronic electrical stimulation during the absolute refractory period of the myocardium improves severe heart failure.Eur Heart J. 2004; 25: 650-655
- Cardiac contractility modulation in the treatment of heart failure: initial results and unanswered questions.Eur J Heart Fail. 2011; 13: 700-710
- Left ventricular systolic dyssynchrony is more common in acute decompensated than chronic stable heart failure with reduced ejection fraction.J Am Coll Cardiol. 2010; 55: A34
- Mechanical dyssynchrony assessed by tissue Doppler imaging is a powerful predictor of mortality in congestive heart failure with normal QRS duration.J Am Coll Cardiol. 2005; 46: 2237-2243
- Comparison of efficacy of reverse remodeling and clinical improvement for relatively narrow and wide QRS complexes after cardiac resynchronization therapy for heart failure.J Cardiovasc Electrophysiol. 2004; 15: 1058-1065
- Prevention of disease progression by cardiac resynchronization therapy in patients with asymptomatic or mildly symptomatic left ventricular dysfunction: insights from the European cohort of the REVERSE (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction) trial.J Am Coll Cardiol. 2009; 54: 1837-1846
- Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms.J Am Coll Cardiol. 2008; 52: 1834-1843
- Cardiac contractility modulation in non-responders to cardiac resynchronization therapy.Europace. 2008; 10: 1375-1380
Published online: February 13, 2012
Accepted: January 21, 2012
Received in revised form: January 13, 2012
Received: October 25, 2011
© 2012 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.