Introduction: Despite strong advances in diagnostic and treatment, heart failure (HF) remains the single largest cause of mortality in the western world.Cardiac contractility modulation (CCM) is a relatively new electrical device-based technique proposed for enhancing ventricular contractile strength of the failing myocardium independent of the synchrony of myocardial contraction.
Two prospective randomized multicenter studies have demonstrated improvements in NYHA functional classification, quality of life . CCM therapy is recommended for patients in sinus rhythm with a left ventricular ejection fraction (LVEF) ≥25-35%, NYHA class III and normal QRS duration, as this subgroup of patients seems to benefit most from the therapy.
Our Center has started its experience with CCM therapy in the population of HF patients with averagely reduced EF (HFmEF) to avoid acting late when the patient is already a candidate for ICD implantation
Methods : Our initial experience with CCM therapy in patients with HFmEF concerns 5 patients (4 M and 1 F) implanted from May 2023 to November 2023 with the following data (expressed in median and interquartile range): mean age 62 (range 57- 67aa); with EF 38% (35-38%), all with primary dilated heart disease, QRS preserved/not widened 100 ms (100-110) in maximal medical therapy and (including sacubitril/valsartan and SLGT2 inhibitors) with evaluation through questionnaires of the quality of life (QoL) MLWHFQ with value 44 (44-50) and KCCQ 40 (39.1-40). For three of them there had been at least one hospitalization for heart failure in the last year.
Results : The follow up (FU) is still short (the first patient implanted reached a FU of 6 months) but in the three patients who reached three months of FU an increase in EF was found with a median value of 41% (43-39 ,5) and an improvement in QoL assessed on the MLWHFQ questionnaires with a value of 18 (27-15) and KCCQ with a value of 72.7 (70-73). None of the five patients have currently had hospitalizations for heart failure.
Conclusions: In our initial experience, CCM proves to be an effective therapy already in the short term, in terms of improvement in EF, QoL and no hospitalization for heart failure. What is highlighted in the literature is confirmed: that is, by acting early we avoid the worsening of EF with consequent ICD implantation, which can be avoided by using all the other weapons available to slow down the progression of heart disease.