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Implantable Device Therapy in Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Maxwell Eyram Afari, Lana Tsao
Cardiac contractility modulation (CCM), shown in Figure 6.2d, applies non-excitatory electrical signals to the cardiac tissue during the absolute refractory period, when the tissue cannot be activated.18 It is similar to a pacemaker system, consisting of a generator system connected to three leads (one atrial lead and two RV leads; Figure 6.2d). After delivery of high voltage (≈7.5 V), atrial-sensed biphasic impulse is sent to the RV septum which triggers the release of calcium in the sarcoplasmic reticulum. Calcium release is important in the cardiac excitation–contraction coupling, ultimately improving contractile performance without extra systolic contractions. Fundamentally, it differs from the pacemaker by the fact that it modulates contraction instead of the rhythm.
A Heart Team or a Heart Failure Interventionalist?
Published in Structural Heart, 2019
A large number of technological and interventional advances have occurred in the treatment of heart failure patients in the last 15 years, and more are being developed, as recently reviewed by Bill Abraham at the TCT meeting. In terms of structural abnormalities, percutaneous treatment of valvular disorders has been achieved, and ventricular support and partitioning devices are in process. Approaches to increase low cardiac output include not only mechanical circulatory support, but novel entities such as cardiac contractility modulation by electrical stimulation. Innovative approaches to elevated cardiac pressures include implantable hemodynamic monitors and even devises to shunt blood from left to right atrium via the interatrial septum. The role of autonomic dysfunction is being addressed by interventions such as renal artery sympathetic denervation and baroreceptor activation. Thus the spectrum of interventional procedures that are being applied to heart failure patients has increased, as has the frequency of their application. This has reignited the discussion of a possible role for a heart failure interventionalist.
Optimizer Smart System for the treatment of chronic heart failure: Overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2021
Habib Hymie Chera, Mohammed Al-Sadawi, Nickolaos Michelakis, Michael Spinelli
Cardiac contractility modulation (CCM) is a novel method for managing moderate to severe heart failure that remains symptomatic despite optimal medical management. CCM is considered an alternative device therapy for patients with HFrEF who do not qualify for CRT. The principle of CCM is delivering an electrical stimulation to the right ventricle to enhance myocardial contractility. CCM provides non-excitatory biphasic high‐voltage signals, which are 7.5 in voltage, and 22 ms in duration, to the right ventricular septum during the absolute refractory period of cardiac cycle [19].
HOPE for a better selection of patients for cardiac contractility modulation
Published in Expert Review of Medical Devices, 2023
Daniele Masarone, Ishu Rao, Giuseppe Pacileo
Cardiac contractility modulation (CCM) is an innovative device-based therapy for the treatment of patients with heart failure (HF) with mildly reduced ejection fraction (HFmrEF) and reduced ejection fraction (HFrEF) with a narrow QRS complex (and therefore with no indication for cardiac resynchronization therapy).