CONGRESS ABSTRACT

INTRODUCTION: In heart failure, profound cellular and molecular changes have recently been documented. Cardiac contractility modulation therapy appears to act precisely at these levels. CASE REPORT: We present the case of a 73-year-old man. In August 2016, the patient experienced an acute coronary syndrome and underwent percutaneous coronary revascularization. In October 2016, a dual-chamber ICD was implanted due to persistent severe left ventricular dysfunction (LVEF 35%) despite optimized medical therapy. After several hospitalizations at other centers for acute decompensated heart failure, he was admitted again in September 2023 for cardiogenic shock, followed by percutaneous transluminal coronary angioplasty of the left main–left anterior descending–right coronary–circumflex arteries with repeat intervention. He was subsequently admitted to our Unit in December 2023 for worsening dyspnea. Transthoracic echocardiography showed a LVEF of 25% and a sPAP of 65 mmHg. NT-proBNP levels 5,439 pg/mL. During hospitalization, after continuous intravenous diuretic therapy, implantation of a CCM device was proposed, with placement of two ventricular leads on the right interventricular septum.Following discharge, the patient reported a significant improvement in clinical status, with no further hospitalizations for heart failure exacerbation, and he underwent regular follow-up at our Heart Failure Clinic. ICD interrogations demonstrated a reduction in ventricular arrhythmic burden. Semiannual echocardiographic evaluations showed persistent severe left ventricular dysfunction with a reduction in sPAP (45 mmHg). In February 2025, the patient was readmitted for acute decompensated heart failure. Echocardiographic findings were substantially unchanged compared with the previous admission, while NT-proBNP levels had increased to 25,062 pg/mL. Interrogation of the CCM device revealed generator battery depletion, which had not been recharged for approximately one month. During hospitalization, intravenous diuretic therapy was administered and the CCM device was reactivated, after which the patient showed clinical improvement and was discharged with recovery from heart failure. CONCLUSION: This case demonstrates that the patient experienced a sustained clinical and quality-of-life improvement while CCM therapy was active, with an improvement of at least one NYHA functional class and a marked reduction in NT-proBNP levels.