THE FIRST EXPERIENCE OF TREATMENT OF PATIENTS WITH CHRONIC HEART FAILURE USING CARDIAC CONTRACTILITY MODULATION DEVICE

To assess efficacy of cardiac contractility modulation (CCM) therapy in patients with chronic heart failure (CHF), 30 Optimizer devices (Impulse Dynamics, Germany) were implanted in 2016, including 27 Optimizer IV devices and 3 Optimizer Smart devices in patients with atrial fibrillation (AF). Most patients suffered from coronary heart disease (87%), 5 of them (17%) had a history of PCI with stenting, and 2 patients (7%) had a history of coronary bypass surgery. Dilated cardiomyopathy was documented in 3 patients (10%) and post-myocarditic cardiosclerosis, in 1 patient (3%). Implantable cardioverters-defibrillators were implanted in 10 patients (33%) and cardiac pacemakers, in 2 patients (6.7%). The indications to implantation of CCM devices were as follows: well-controlled CHF II III (NYHA), left ventricular (LV) ejection fraction (EF) 20 40% according to the echocardiography data, QRS width <130 msec, presence of the sinus rhythm if the Optimizer IV device was implanted, and atrial fibrillation if the Optimizer Smart device was implanted. The study subjects’ assessment included 12 lead ECG, transthoracic echocardiography, 6 minute walk test, N terminal pro-brain natriuretic peptide (NT proBNP) testing, 24 hour Holter monitoring, and the quality of life assessment using Minnesota Living with Heart Failure Questionnaire. The follow-up period was 4±1.4 months for the patients with the Optimizer IV devices and 2 months with the Optimizer Smart devices. In 17 cases (57%), decreased energetic parameters within the effective range in the early postoperation period were required. In 14 patients (46.7%), 3 months after the procedure, the amplitude of stimuli which were previously bothering increased. In 27 patients with CCM devices, LV EF raised on the average by 8%, the quality of life improved on the average by 11 points, NT proBNP decreased by 488 ng/l, and the percentage of paced complexes was 82±12.1%, i.e. more than the recommended %. An improvement (mild increase in LV EF and quality of life) was also found in the three patients with Optimizer Smart devices despite a short follow-up period. Thus, the CHF treatment using implantable CCM devices leads to a considerable improvement of the quality of life and physical working capacity, as well as has an effect on the cardiac contractility parameters in these subjects. At the same time, further detailed studies of the long-term outcomes and safety of the CCM therapy, as well as defining clear indications to reach the maximal effect of the CCM device implantation are needed. The clinical efficacy, the complication rate, and the health economics of CCM therapy should be compared with those for the available treatment techniques with the proven benefit on the quality of life, hemodynamic parameters, hospitalizations, and survival of patients with CHF. Of note, among the surgical methods of CHF management, CCM therapy is considered a minimally invasive intervention; the implantation technique is similar to that of other antiarrhythmic devices.

chronic heart failure, coronary heart disease, optimal medical therapy, cardiac contractility modulation, quality of life

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