PMID- 18776196
OWN - NLM
STAT- MEDLINE
DCOM- 20090212
LR  - 20081121
IS  - 1532-2092 (Electronic)
IS  - 1099-5129 (Linking)
VI  - 10
IP  - 12
DP  - 2008 Dec
TI  - Cardiac contractility modulation in non-responders to cardiac resynchronization 
      therapy.
PG  - 1375-80
LID - 10.1093/europace/eun257 [doi]
AB  - AIMS: Cardiac resynchronization therapy (CRT) has become a standard therapy in 
      cases of heart failure and asynchrony. Unfortunately, 20-30% of patients were 
      non-responsive (NR) to CRT. In this report we used cardiac contractility 
      modulation (CCM) as an adjunctive measure in NR patients. METHODS AND RESULTS: 
      Sixteen NR patients, mean age 65 +/- 9 years, mean ejection fraction 27.3 +/- 
      7.4%, and New York Heart Association (NYHA) class III (n = 9) or IV (n = 7) 
      despite CRT plus optimized medical therapy, received an additional 
      CCM-implantation contra-lateral to the existing CRT system (OPTIMIZER III, 
      Impulse Dynamics, Orangeburg, NY, USA). Cardiac contractility modulation delivers 
      non-excitatory high-energy stimulatory impulses during the absolute refractory 
      period, thus improving contractility [left ventricular (LV) dp/dt)] by 
      stimulating the septum with two screw-in leads and one additional atrial lead for 
      triggering the impulses. Acute LV dp/dt changes induced by CCM stimulation were 
      measured by 5F Millar catheters placed in the LV during the implantation 
      procedure in 14 of 16 cases. Patients were followed prospectively. Left 
      ventricular dp/dt increased from a mean of 568 +/- 153 to 646 +/- 147 mmHg/s 
      (+14%, P < 0.001) in the acute intraoperative testing. We noted the following 
      complications and events during a follow-up of an average of 147 +/- 80 days 
      (range 68-326) after CCM: intraoperative ventricular flutter needing 
      cardioversion (n = 1), atrial lead dislocation (n = 1), coronary sinus (CS) lead 
      dislocation (n = 1), painful stimulation requiring repositioning of septal leads 
      (n = 1), true defibrillator shocks (n = 3), cardiac decompensations (n = 3), 
      atrial fibrillation (n = 4), renal failure (n = 1), and pneumonia (n = 2). NYHA 
      class improved from 3.4 to 2.8 (P < 0.01), and the ejection fraction increased 
      from 27.3 +/- 5 to 31.1 +/- 6 (P < 0.01). Three patients (19%) died suddenly 
      presumably due to electromechanical dissociation after 318, 104, and 81 days. No 
      electrical interference was observed between the CCM and CRT systems, and in 
      particular, at no time was the CRT-implantable cardioverter-defibrillator found 
      to be delivering inadequate shocks. CONCLUSION: The CCM method is feasible and 
      could be applied with calculated risks as a possible useful adjunct in CRT-NR 
      when no other options are available; however, mortality and event rates are high 
      in this very sick population.
FAU - Nagele, H
AU  - Nagele H
AD  - St Adolfstift, Medical Clinic, Reinbek, Germany. 
      herbert.naegele@krankenhaus-reinbek.de
FAU - Behrens, S
AU  - Behrens S
FAU - Eisermann, C
AU  - Eisermann C
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20080905
PL  - England
TA  - Europace
JT  - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal 
      of the working groups on cardiac pacing, arrhythmias, and cardiac cellular 
      electrophysiology of the European Society of Cardiology
JID - 100883649
SB  - IM
MH  - Aged
MH  - *Cardiac Pacing, Artificial
MH  - Female
MH  - Heart Failure/*diagnosis/*prevention & control
MH  - Humans
MH  - Male
MH  - Treatment Failure
MH  - Ventricular Dysfunction, Left/*diagnosis/*prevention & control
EDAT- 2008/09/09 09:00
MHDA- 2009/02/13 09:00
CRDT- 2008/09/09 09:00
PHST- 2008/09/09 09:00 [pubmed]
PHST- 2009/02/13 09:00 [medline]
PHST- 2008/09/09 09:00 [entrez]
AID - eun257 [pii]
AID - 10.1093/europace/eun257 [doi]
PST - ppublish
SO  - Europace. 2008 Dec;10(12):1375-80. doi: 10.1093/europace/eun257. Epub 2008 Sep 5.