Associazione Nazionale Medici Cardiologi Ospedalieri




Lamaida Norman Salerno(SALERNO) – clinica Trusso | Cerciello Antonio Ottaviano(Napoli) – Clinica trusso

Introduction: Cardiac resynchronization therapy (CRT) reduces hospitalizations and mortality in patients with advanced heart failure and prolonged QRS duration. In patients with a narrow QRS complex, CRT has failed to reduce the rate of death or hospitalization. Thus, there is an alternative device-based treatment for patients with persistent symptoms despite best medical therapy (BMT). 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. In this work, we show the use of CCM therapy in an older patient with non-ischemic dilated cardiomyopathy without indication to CRT, demonstrating the clinical benefit of this novel HF device-based therapy.

Case Report : We present a 72-year-old patient successfully implanted with a cardiac contractility modulation (CCM) system. The patient had arterial hypertension, and a history of chronic heart failure (HF) due to non-ischaemic cardiomyopathy with severe systolic dysfunction (left ventricular ejection fraction [LVEF] 30 %). Due to persistent severe HF symptoms (NYHA class III/IV) despite BMT (bisoprolol 5 mg/die, sacubitril/valsartan 49/51 mg bis in die , SLGT2 inhibitors and eplerenone 25 mg/die), the NT-proBNP value was 1300 pg/mL, and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) score was 80 points. The patient was referred for implantation of a CCM system as a first-line cardiac device treatment. The patient did not fit the criteria for cardiac resynchronization therapy (CRT) due to narrow QRS. At 3-month follow-up, the patient already experienced significant improvements in terms of quality of life with an MLWHFQ score of 20 and a decrease in BNP to 600 pg/mL In addition, no HF-related hospitalizations was observed. At 12-month follow-up, no HF-rehospitalizations occurred and the patient had stable NYHA class II , an LVEF of 40% ( an increase in systolic function of the left ventricle using the Simpson biplane method) an MLWHFQ score of 6, an NT-proBNP value of 300 pg/m and stable renal function.

Conclusions : in this report, CCM proves to be an useful and safe HF device therapy for HFrEF not eligible for CRT implantation, led to improved quality of life and a reduction in HF-related hospitalizations in an older patient with HFrEF due to non-ischemic dilated cardiomyopathy.