Abstract 14920: Long-Term Efficacy of Cardiac Contractility Modulation: Single Center Experience in 81 Patients
Introduction: Cardiac contractility modulating (CCM) signals are high intensity electrical impulses applied to the septum during the absolute refractory period that are intended to enhance the strength of left ventricular contraction. Randomized studies demonstrated in patients with symptomatic systolic heart failure (HF) and severely depressed left ventricular ejection fraction (LVEF) that CCM improves exercise tolerance as indexed by peak VO2. Other indexes of exercise tolerance (e.g., 6 minute hall walk) and quality of life (NYHA Class and MLWHFQ) have also been shown to improve in a 3-6 months follow up period. Actually, there is no data available on the long-term efficacy (> 6 months) of CCM.
Methods: 81 consecutive patients with an implanted CCM were included into the study. Responder rates in terms of improvement of NYHA class and changes in mean LVEF, MLWHFQ, NT-pro BNP and peak VO2 were analyzed during a mean follow up period of 34.3 ± 28 months (range 6-123 months). All patients had a concomitant ICD.
Results: 81 consecutive patients with a mean age of 61 ± 12 years and a mean LVEF of 23 ± 7% were uneventfully implanted with a CCM device between 2004-2012. The underlying etiology for heart failure was coronary artery disease (CAD) in 48 (59.3%) patients, idiopathic dilated cardiomyopathy (IDC) in 31 (38.3%) patients and hypertrophic cardiomyopathy (HCM) in 2 (2.5%) patients. During a mean follow up period of 34.3 ± 28 months the mean ejection fraction increased from 23.3 ± 7.6 to 29.3 ± 8.9% (p < 0.05), the mean NYHA class improved from 3.1 ± 0.4 to 2.1 ± 0.7 (p < 0.05), mean NT-pro BNP decreased from 4395 ± 3818 to 2762 ± 3490 ng/l (p < 0.05), mean MLWHFQ improved from 49.9 ± 17.7 to 32.2 ± 18.2 pts and mean peak VO2 increased from 13.9 ± 3.3 to 15.2 ± 3.7 ml/kg/min (p < 0.05). The overall clinical responder rate (improvement of NYHA class) was 74.1 %. 21 (25.9%) patients died during follow up, 11 (52.4 %) patients due to cardiac conditions, 10 (47.6%) patients suffered from non-cardiac death.
Conclusions: 1) Cardiac Contractility Modulation improves significantly quality of life, exercise capacity, NYHA class and LVEF and reduces NT-pro BNP levels during long-term follow up.
2) Randomized trials addressing to mortality are mandatory.
- © 2013 by American Heart Association, Inc.